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Practical Nursing 

A Text-Book for Nurses and a 

Hand-Book for all who 

Care for the Sick 



By 



Anna Caroline Maxwell 

Superintendent of Presbyterian Hospital School of Nursing 

and 

Amy Elizabeth Pope 

Instructor in Presbyterian Hospital School of Nursing. 



G. P. Putnam's Sons 

New York and London 

Cbe fmickerbocfcer press 

1907 



JUN 



7 1«T 



Copyright, iqo7 

BY 

G. P. PUTNAM'S SONS 



TTbe Iftnicfeerbocfter press, Iftew ]£orfc 



PREFACE 

IN writing this book, the authors have constantly 
kept in view a two-fold aim — first, to prepare 
a volume adapted at every point to use as a text-book 
for nurses; and second, to make this volume so simple 
and practical in its statements that it will be service- 
able, not to nurses only, but to all who wish to ac- 
quaint themselves with the conditions and procedures 
necessary to the proper care of the sick. All con- 
sideration of anatomy and physiology, of the physi- 
ology of obstetrics, and of the care of the patient 
during and after delivery we have omitted, because 
these matters can only be treated to good purpose at 
greater length than the plan of this book permits, 
and because most schools of nursing provide them- 
selves with one or another of the many books devoted 
solely to these subjects. 

We are glad here to acknowledge gratefully the 
many and valuable suggestions made by friends 
from their wide experience, special thanks being due 
to W. Gilman Thompson, M.D., Linsly R. Williams, 
M.D., Anna Rand Young, M.D., and Frederick James 
Barrett, M.D., for helpful criticism. 

We send forth our book — a book designed to give 
in the simplest and most direct way the information, 
which experience has taught us is most needed, upon 
the subjects it treats — in the hope that it will be 

iii 



iv Preface 

practically helpful. If it succeeds in aiding those who 
are devoting themselves to the alleviation of human 
suffering, we shall feel that it has accomplished its 
mission. 

A. C. M. 

A. E. P. 

Presbyterian Hospital School of Nursing, 
New York City, 1907. 



CONTENTS 



CHAPTER I 



PAGE 



Qualifications of a Nurse. i 

Physical Qualifications: Health. Cleanliness. 
Fresh Air. Prevention of Disease. Care of the 
Hands. 

Mental Qualifications: Education. Perception. 
Judgment. Order. 

Moral Qualifications : Personal Neatness. Econ- 
omy. Courtesy. Obedience. Promptness. Self- 
Control. Sympathy. Tact. Truthfulness. Dignity. 
Respect for Positions and Officers. Respect for 
Secrets. The Florence Nightingale Pledge. 

CHAPTER II 

Bacteriology ...... 13 

Important Facts in the History of Bacteriology: 
Preparation of Culture Media — Making Cultures. 
The Nature and Classification of Bacteria. Where 
Bacteria are found. Methods of Destroying 
Germs. Disinfectants and Antiseptics. Rules to 
be Followed in Making Solutions. 

CHAPTER III 
Ventilation ...... $3 

Methods of Ventilation. Heating. Prevention 
of Air Contamination by Proper Care of Uten- 
sils, Sinks, Hoppers, etc. 
v 



vi Contents 



CHAPTER IV 

PAGE 

Care of the Ward. ..... 40 

General Care of the Ward and its Furnishings. 
How to Remove Stains from Wood. How to 
Clean Brass, Copper, Nickel, Porcelain, and 
Marble. Care and Disinfection of Mattresses, 
Pillows, and Bed-Linen. How to Remove Stains 
from Linen. Amount of Linen Required for 
Ward Use. 



CHAPTER V 

Bed-Making, etc. ..... 52 

How to Make a Closed Bed, an Ether Bed, a 
Fracture Bed, a Bed with a Patient in it. How 
to Change the Nightgown, the Under Sheet. 
How to Turn and Change a Mattress with the 
Patient in Bed. How to Move a Patient from 
one Bed to Another. Lifting and Carrying. 
How to Draw a Patient up in Bed. How to sit a 
Patient up in Bed. How to Get a Patient up 
in a Chair. "Morning Rounds." 



i & 



CHAPTER VI 
Care and Comfort of the Patient . . 64 

Care of Patient on Admission. Care of Pa- 
tient's Clothes. Methods of Making Patient 
Comfortable. How to Give and Remove the 
Bed-Pan. Care of Patient's Mouth. Preven- 
tion and Care of Bed-Sores. Restraining Pa- 
tients. Preparing Patient for the Night. Care 
of Patient at Night. Care after Death. 

CHAPTER VII 
Symptoms . . • . . . . .79 

Difference between Subjective and Objective 
Symptoms. Chill. Colour. Coma. Cough. Cry. 



Contents vii 

PAGE 

Cyanosis. Dyspnoea. Excreta: Sputum ; Faeces ; 
Sweat or Perspiration; Urine. Expression. Eyes. 
Hearing. Pain. Paralysis. Position. Pulse. 
Rash. Singultus. Respiration. Restlessness. 
Condition of the Temperature ; of the Tongue. 
Tremor or Subsultus. Tympanites or Flatulence. 
Vomiting. 

CHAPTER VIII 
Temperature, Pulse, and Respiration . 94 

Forces Controlling Bodily Temperature. The 
Normal Temperature and Causes of Variation. 
How to Take and Record the Temperature. 
Care of the Thermometer. The Pulse: The Rate 
and Character of the Normal Pulse. Variation 
from the Normal. Object of Respiration. Means 
by which Object is Obtained. The Ratio of 
Respiration to Pulse. Stertorous Breathing. 
Dyspnoea. (Edematous Breathing. Cheyne- 
Stokes Respiration. Hiccough. 

CHAPTER IX 

Baths and Packs ..... 107 

Uses of Baths. Cleansing Bath. Bed Bath 
Washing the Hair. Infants' Cleansing Bath. 
Baths and Packs for Stimulation in Nervous 
Exhaustion. The Drip Sheet. Cold Tub Baths. 
Baths in Hyperpyrexia. Tub Baths. Sponge 
Baths. Slush Baths. Hot Packs and Baths to Re- 
lax Spasms or Cause Perspiration. Modified Hot 
Baths. Hot Air and Vapor Baths. Sitz Baths. 
Foot Baths. Continuous Baths. Medicated 
Baths. 

CHAPTER X 
Counter-Irritants . . . . .130 

Inflammation. Use and Character of Counter- 



viii Contents 



PAGE 

Irritants. Hot-Water Bags. Mustard Foot-Baths. 
Poultices. Fomentations. Iodine. Ammonia. 
Chloroform. Liniments. Guaiacol and Glycerine. 
Cupping. The Cautery. Vesicants. Cantharides. 
Local Applications Other than Counter-irritants. 
Ice Poultices. Ice-Caps. Ice Coil. Ice Compresses. 
Antiphlogistine. Starch Poultices. Ointments. 
Leeches. 



CHAPTER XI 
The Urine ....... 148 

Nature of Urine. Normal Urine. Specific 
Gravity. Quantity. Meaning of Oliguria, Poly- 
uria. Suppression and Retention. Colour. Re- 
action. Urea. Uric Acid. Test for Urates. 
Abnormal Constituents of Urine. Albumen. 
Test for Albumen. Bacteria. Bile. Blood. 
Glucose. Fehling's Test for Glucose. The Fer- 
mentation Test for Glucose. Hasmoglobinuria. 
Pus. Renal or Tube Casts. Urinary Calculi. 
The Collection and Care of Urine Specimens. Ca- 
theterisation. Bladder Irrigation. 

CHAPTER XII 
Douches ....... 165 

Vaginal, Intra-Uterine, Spinal, Nasal, and Aural 
Douches. Care of Douche Utensils. 

CHAPTER XIII 
Enemata . . . . . . -171 

Uses and Varieties of Enemata. How to Give 
Enemata. Rectal Irrigation. Care of Rectal 
Tubes. Examination of Faeces. 



Contents ix 

CHAPTER XIV 



PAGE 



Lavage, etc. . . . . . i 

Lavage. Gavage. Xasal Feeding and Feeding 
after Intubation. Test Meals. 



CHAPTER XV 
Administration of Medicines . . . i^o 

Rules for Estimating the Percentage of So- 
lutions. To Estimate a Dose of a Different 
Fractional Part of a Grain from the Drug on 
Hand. To Reckon a Child's Dose. Apothecaries' 
Weight. Apothecaries' Measure. The Metric 
System. Symbols and Abbreviations Used in 
Prescriptions and Chemistry. Absorption of 
Medicines. Different Methods of Administering 
Medicines. Points to be Remembered when 
Measuring Medicines. Food and Drugs. Hypo- 
dermics. Methods of Giving Medicine by In- 
halation, by Inunction, by Rectum. Application 
of Medicine to the Eye. Medicine List. Order 
Book. 

CHAPTER XVI 

Emergencies . . . . . .213 

surgical emergencies. 

Burns and Scalds. Contusions. Dislocations. 
Foreign Bodies in Ears, Eyes, Xose, Trachea, and 
Tissues. Fractures. Haemorrhage. Shock. Sprains 
Wounds 

MEDICAL EMERGENCIES. 

Apoplexy, Asphyxia (Artificial Respiration). 
Collapse. Convulsions. Drowning. Epilepsy. 
Fainting. Hysteria. Intoxication. Poisons. Sun- 
strokes. 



x Contents 

CHAPTER XVri 

PAGE 

Bandages, Strapping, and Splints . . 242 

Use, Nature, and Sizes of Bandages. How to 
Make Bandages. Points to Remember in Bandag- 
ing. How to Make and Apply Plaster Bandages; 
Circular, Spiral, Spiral Reverse, Recurrent, and 
Figure-8 Bandages. Bandages for Head, Eyes, 
Jaw, and Breasts. Velpeau's Bandage. Spica of 
Shoulder. Hand, Arm, Elbow, Knee, Leg, Foot, 
and Heel Bandages. Tailed Bandages. Binders 
and Slings. Handkerchief Bandages. Strapping 
of Chest, Knee, and Ankle. Splints: Coaptation, 
Angular, and Volkman's. Buck's Extension. 
Inclined Plane. Vertical Extension. Restraining 
Children. Bradford Frame. 

CHAPTER XVIII 
Preparation for Gynaecological Treat- 
ments . . . . . ' . 281 

Gynaecological Positions. How to Prepare the 
Patient for Examination. How to Hold the Sims 
Speculum. 

CHAPTER XIX 
Surgical Dressings ..... 286 

The Sterilization and Cleansing of Instruments 
and Utensils for Surgical Dressings. The Prep- 
aration for and Dressing of Wounds. 

CHAPTER XX 
Treatment Requiring Aseptic Precau- 
tions ...... 294 

Preparation for Aspiration of the Abdomen, 
Thorax, and Pericardium. Exploration of the 
Thorax and Other Cavities. Lumbar Puncture. 



Contents xi 



PAGE 



Phlebotc: Hypodermoclysis. Infusion. 

Intravenous Infusions. Injections of Antitoxine, 
etc. Intubations. Throat-Cultures. Blood- 
Smears and Cultures. 



CHAPTER XXI 
Care of Patient before and after Opera- 
tion 315 

Preparation of Patient for Operation. Care 
after Operation. 



CHAPTER XXII 
OPERATixG-Room Technique, etc. . . 320 

Care and Temperature of the Operating Room. 
Care of the Patient during Operation. Disin- 
fection of the Hands. Preparation of Dressings, 
Ligatures, etc. Preparation for Operation in a 
Private House. List of Principal Operations. 

CHAPTER XXIII 

A Synopsis of Important Diseases . -33 7 

Part i. Communicable, Contagious, and 

Infectious Diseases: 

Isolation and Disinfection in Infectious 
Diseases. Anthrax. Chicken-pox. Cholera. 
Diphtheria. Pseudo-Diphtheria. Dysentery. 

Ersyioelas. Gonorrhoea. Hydrophobia. Influ- 
enza. Leprosy. Malaria. Malta Fever. Measles. 
Measles (German). Meningitis. Mumps. Plague. 
Pneumonia. Rheumatic Fever. Scarlet Fever. 
Septic Diseases. Small-Pox. Syphilis. Tetanus. 
Tuberculosis. Typhoid Fever. Typhus Fever. 
Whooping Cough. Yellow Fever. Diseases Due 
to Animal Parasites. 



xii Contents 

PAGE 

Part ii. Non-Infectious Diseases: 

Constitutional Diseases: Diseases of the Brain, 
Spinal Cord, and Nerves; of the Respiratory 
Organs; of the Heart, Arteries, and Veins; of the 
Blood and Ductless Glands; of the Digestive 
Organs; of the Urinary System; of the Uterus 
and Appendages; of the Muscles; of the Bones; 
of the Ear; of the Eye. 

CHAPTER XXIV 
Food 472 

The Nature of Food. Digestion. Infant Feed- 
ing. Modification of Milk. Cooking, Serving. 
Diet in Disease. 

CHAPTER XXV. 
Massage ....... 500 

History of Massage. Use of Massage. Move- 
ments. Methods of Giving. Effects. 

Glossary . . . . . . 507 

Index ....... 515 



Practical Nursing 



CHAPTER I 

QUALIFICATIONS OF A NURSE 

Physical Qualifications: Health, Cleanliness, Fresh Air, 
etc., Prevention of Disease, Care of the Hands. 

Mental Qualifications: Education, Perception, Judgment, 
Order. 

Moral Qualifications : Personal Neatness, Economy, Court- 
esy, Obedience, Promptness, Self-control, Sympathy, Tact, 
Truthfulness, Dignity, Respect for Physicians and Officers, 
Respect for Secrets. The Florence Nightingale Pledge. 

WOMEN about to enlist in the profession of nursing 
are inclined to approach the career with too 
much sentiment, and, consumed with the altruistic 
spirit, allow this to blind them to its practical side. 
That there is a very practical side no nurse of any 
experience can deny. Still it must be borne in mind 
that the calling is a noble one, the alleviation of hu- 
man suffering being its primary object, and nurses 
should make their work their first thought, allowing 
no outside distractions to lure them from the path 
of duty. By this we do not mean to imply that they 
are to be debarred from all forms of recreation. They 
need to have their minds diverted more than the 
people engaged in most occupations, because upon 
them depends the atmosphere of the sick room, and 
they must provide the cheerfulness and brightness 
that is so often lacking there. They should, however, 
have a proper comprehension of the responsibility 



Practical Nursing 



they assume when they allow themselves to be en- 
trusted with human lives, and should bring to their 
work a capacity for self-sacrifice, at the same time 
keeping in mind the fact that to be able to give of 
one's best all self-sacrifice must be tempered with a 
certain amount of self-consideration. 

The qualifications of a good nurse may be classified 
as physical, mental, and moral. 

Physical Qualifications 

Health. 

A good constitution is indispensable. Women 
who are unsound of body or of excessively high 
nervous organisation, or who are incapable of great 
physical endurance ought not to entertain the 
idea of becoming nurses. More than this, even 
a strong physique will not suffice unless it be kept 
vigorous by strict obedience to the laws of hygiene. 

Cleanliness. — Personal cleanliness must be rigidly 
observed. The daily bath must never be omitted. 
The finger nails should receive a great deal of careful 
attention, as they form a convenient hiding-place 
for germs. The cuticle should be cleaned frequently, 
even though it does not appear dirty, and the nails 
should be kept short. Nature supplies the hair with 
an oil that keeps it soft and pliable. When the oil 
is in excess, it attracts dust and if not kept clean may 
become a fruitful source of contagion. The hair 
should therefore be thoroughly washed every two 
weeks, brushed carefully back from the face, and 
dressed in a simple manner. The breath must be 
kept sweet by attention to the condition of the 
stomach and the teeth. The teeth should be washed, 
and the throat gargled twice a day, and it is advisable 



Qualifications of a Nurse 3 

to have the teeth examined by a dentist at least twice 
a year. The clothing should be scrupulously clean, 
underclothes and uniforms being changed often 
enough to secure a desirable freshness. In working 
over a patient, the nurse is brought in very close 
contact, therefore all odors or perfumes that might be 
distasteful to the sick should be avoided. 

Fresh Air and Exercise. — Nothing is more con- 
ducive to good health than fresh air. Nurses should 
always sleep with the window open winter and 
summer. They should go out of doors as much as 
possible during their free hours, although it costs them 
an extra effort to do so. No amount of exercise 
indoors will do them so much good as a brisk walk 
in the open air. Walking gives exercise to almost 
every muscle of the body, it accelerates the circula- 
tion, clears the brain, and gives new life and vigour. 

Food and Sleep. — Wholesome food, well cooked 
and taken at regular intervals in sufficient quantities, 
while hot, without too much haste is also of the utmost 
importance. The habit of rapid eating with insuffi- 
cient mastication and the use of unwholesome and 
indigestible food taken after a hard day's work in 
hospital wards is one of the frequent causes of illness 
amongst student nurses. 

Too much stress cannot be laid on the need of rest. 
At least six hours' sleep is required in order to do the 
best work, and recreation should not frequently be 
allowed to interfere with the hours for sleep. 

Prevention of Disease. — To maintain good 
health it is incumbent upon nurses to take every 
precaution possible to check in time the inroads of 
disease. By attending immediately to symptoms of 
indigestion, constipation, sore throat, and similar 



4 Practical Nursing 

ailments and reporting them at once to the proper 
authority, they may often prevent a severe illness. 
They should not attempt to prescribe for themselves, 
because indiscriminate dosing often begets the drug 
habit which cannot be too carefully guarded against. 
Those in authority in a school for nurses are respons- 
ible for the health of every student. It is due to 
them, therefore, that they be apprised of any tendency 
to disease in order that they may give the advice that 
their experience warrants. At the same time, the 
student nurse must remember that her superiors do 
not expect her to take up their time with petty com- 
plaints of fatigue or of slight indisposition. She must 
inure herself to hard work and go on in spite of diffi- 
culties with the same kind of fortitude that is expected 
from a soldier on the field of battle. 

Care of the Hands. — A nurse must always be on 
her guard against contagion. Proper care of the 
hands is one of the most important precautionary 
measures, and she must remember that negligence in 
this matter endangers not only her own life, but the 
lives of others. After handling infectious cases, she 
must disinfect her hands before touching anything 
with them and even before washing them, by sub- 
merging them in i-iooo bichloride or other disin- 
fectant for from three to five minutes. Furthermore, 
in order that they may be easily disinfected, she 
must keep them in good condition: (i) by using 
forceps, whenever practicable to handle infected 
dressings, etc.; and (2) by using after washing, as 
often as possible, some lubricating hand-wash, and 
before retiring, a reliable ointment or cold cream well 
rubbed in, since the constant use of water and dis- 
infectants has a tendency to roughen the skin. To 



Qualifications of a Nurse 5 

prevent infected fingers, she must keep a constant 
watch for hangnails, scratches, and cuts, protecting 
the latter with flexible collodion, or, if of any conse- 
quence, with sterile gauze or finger cots. 

Mental Qualifications 

Education. — The acquirements of the higher edu- 
cation, although always desirable in probationers, 
are not absolutely essential to their success. Women 
wishing to prepare for such responsible work must, 
however, present evidence of a high order of intelli- 
gence and of a desire to learn and comprehend the 
underlying principles of the profession. 

Perception. — Perception is probably the mental 
faculty that is called into play most constantly in 
nursing. Nurses must be quick to observe minute 
details, and equally quick to act intelligently on their 
observations. They must note instantly any un- 
favourable change in a patient's condition, since a 
failure to do so might result in his death. If a 
patient's position becomes uncomfortable, if his 
pillows are out of place, if he be exposed to a draught, 
or if the light shines in his eyes, they should perceive 
it at once. If noise or too prolonged visits of friends 
are annoying the patient this should be seen and 
prevented. When assisting at an operation or treat- 
ment they should anticipate the needs of the doctor 
and when being shown how to do anything, either by 
the doctor or another nurse, they should pay the 
strictest attention, in order that it may not be 
necessary to have the instruction repeated. 

Judgment. — The nurse's intelligence should be so 
keen that when two conditions are placed before her, 
she can weigh them quickly and decide the relative 



Practical Nursing 



value of each to the matter in hand. Nurses who 
have never held responsible positions are very 
apt to fail at first in this respect, but by always 
observing where their decision has erred they will 
soon learn by their failures. Women devoid of 
this quality have no legitimate place in the profession 
of nursing. 

Order. — Nurses must early cultivate an orderly 
habit of mind. They should make an inventory 
every morning of their day's work, planning it so that 
the greatest amount can be done in the least possible 
time. This will obviate useless expenditure of 
mental and physical strength. If they cultivate this 
habit of mind, they will not be likely to tolerate 
any form of disorder in the things about them, or to 
allow confusion where they are working. The rule, 
"A place for everything and everything in its place" 
is nowhere more necessary than in the hospital ward 
or the sick room. Great indeed must be the emer- 
gency which will excuse putting anything where it 
does not belong. Failure to find important instru- 
ments in place and in order may cost a life. 

The development of all the above qualities can be 
helped by the proper kind of reading. When the 
nurse gets time for the improvement of her mind she 
should take care to consume the right kind of mental 
food. Select good books. Life is too short to waste 
on books that do not give anything helpful. Read 
slowly to develop the perception. One book read 
appreciatively is better than a dozen that are half 
digested. Exercise a sense of fitness in your choice. 
There are certain books for the tired hours and others 
that should be read only when the mind and body 
are vigorous. 



Qualifications of a Xurse 7 

Moral Qualifications 

The moral qualifications of a nurse are so numerous 
and so important that a volume might be devoted 
exclusively to them. 

Personal Xeatxess. — The Uniform : Xurses 
should always be immaculately clean, trig, and tidy, 
in the English sense "very fit." Their uniform symbol- 
ises the discipline of the soldier, and carries with it 
a certain sense of moral obligation. It should consist 
of a simply made washable material that is easily 
laundered, and of a colour pleasing to the eye that 
does not readily fade. Stiffly starched aprons, skirts, 
and dresses should be avoided as a disturbing ele- 
ment to the patient. The uniform should be kept 
in perfect order. There is no excuse for rips, missing 
buttons, or slovenly belts. As a matter of fact, a 
woman with a proper sense of self-respect usually 
gives her appearance the attention it requires. 

Economy. — Xurses should cultivate habits of 
economy and thrift in their personal expenditures. 
A systematic keeping of accounts while in the school 
of nursing is earnestly recommended, since those who 
are frugal where their own belongings are concerned 
are more likely to be careful of the property of others. 
Pains should be taken to learn the comparative cost 
of supplies and to use always the cheapest that will 
answer the requirements. It seems almost incredible 
that it should be necessary to dwell upon this sub- 
ject, but complaints come very frequently from the 
homes to which nurses go of their heedless extrava- 
gance in the use of supplies and their careless destruc- 
tion of expensive furniture and linen. 

Courtesy. — Xurses should .never be so absorbed 



8 Practical Nursing 

with their work that they cannot practise courtesy. 
They should be courteous toward every one with 
whom they come in contact. The friends of the 
family deserve some attention, although reports of 
the patient's condition must be given with great 
caution. The servants, upon whom extra work 
always falls at such a time, when sickness is present 
in the family, if treated with consideration, will be 
friendly and helpful. People visiting the hospital 
frequently complain justly of the lack of consideration 
shown them. Patients and their friends are often 
very trying, to be sure, but this is no excuse for 
impoliteness. To enter into argument may jeopard- 
ise your self-control. If an important matter is 
involved, offer to refer it to higher authority and 
show in every way a desire to respect their wishes. 

Obedience. — No one should take up nursing who 
is not willing to give prompt and unquestioning 
obedience to authority. Women are not admitted 
to schools for the training of nurses until they are 
twenty-one years of age. They enter then of their 
own free will; therefore, there is no excuse for dis- 
obedience. The highest order of discipline must be 
maintained, and the rules are in many respects very 
strict, but no large institution can be successfully 
run on any other basis. Obedience includes not only 
the keeping of rules but also the absolute and accurate 
carrying out of the doctor's orders regarding his 
patients. Intelligent obedience is a rare quality, 
but one which the medical profession prizes most 
highly. 

Promptness. — Promptness involves precision in 
regard to time. It is necessary to learn to gauge 
the time it is going to take to accomplish a piece of 



Qualifications of a Nurse 9 

work so that it can be finished at the moment pre- 
scribed. It must not be begun when it ought already 
to be finished, as this interferes with carrying out 
orders and makes inroads upon the next duty. 
Nurses must learn to move quickly, but quietly — 
to make h&ste without hurry. Patients become 
tired if too much time is consumed over a treatment 
or the making of their toilets, and nurses who are 
not quick and prompt under ordinary conditions 
are likely to be found sadly wanting in emergencies. 

Self-Coxtrol. — Self-control is a very important 
quality in nurses. The distressing scenes they are 
constantly obliged to witness call for cool heads and 
steady nerves. They must, therefore, learn to master 
their emotions. Patients are often extremely irritable 
and it requires great self-control not to be affected 
by their weakness or ill-temper, but it is necessary 
to appear calm no matter what the provocation may 
be. 

Sympathy. — Nurses are sometimes accused of a 
lack of sympathy. They should not allow their 
daily work so to inure them to suffering that they 
cannot feel a reasonable amount of compassion for 
a person in pain. Patients are often sadly in need of 
an encouraging word. A gentle touch or a kindly 
smile may do much toward carrying a sufferer over 
a hard place. The nurse's sympathy must not deter 
her, of course, from carrying out orders that will 
benefit the patient. There is, however, a way of 
doing this without wounding his sensibilities. 

Tact. — Tact has been defined as "the ready power 
of appreciating and doing what is required by cir- 
cumstances. " In other words, tact is doing and 
saying the right thing at the right moment, or it is 



io Practical Nursing 

an appreciation by us of the things that those with 
whom we are dealing think we should do. There is 
probably no other qualification so indispensable 
to a nurse's success. It presupposes great intuitive 
power, a wide comprehension, and the ability to read 
human nature quickly. Only one possessed of this 
ability can really manage others or call forth the best 
that is in them. Tact must be deployed daily while 
in the hospital in keeping exacting patients content 
with their due share of attention to the end that 
others who are less exacting but who are in need of 
an equal, if not a greater, amount of care, may not 
be neglected. To secure proper discipline in the 
sick room is an essential part of a nurse's duty. The 
comfort and well being of the patient must be her 
first thought. To inspire the family and friends with 
confidence in her judgment, to make them accept 
her decisions readily as to what is best for the invalid 
is no easy task, and one often requiring infinite tact 
and patience. To know when to speak and when to 
keep silence; to know when to be present and when 
to retire, these are points requiring tact of high order. 
Truthfulness. — It ought not to be necessary 
to enumerate truthfulness among the qualifications 
of a nurse. But it must be borne in mind that in 
the hospital truthfulness takes on a very broad 
meaning. There it means not only an unwillingness 
to tell a downright untruth but also the possession 
of an honesty of purpose that will lead to the frank 
acknowledgment of an error and the prompt con- 
fession of anything that has been left undone. It 
means also absolute accuracy of statement and 
avoidance of all exaggeration. Truthfulness also 
involves the conscientious performance of all the 



Qualifications of a Nurse n 

minute details which have been considered necessary 
in constructing the different routine procedures; 
whether their omission is noticeable or not. 

Dignity. — Nurses should always be dignified and 
cordial without being familiar. The bedside is not 
the place for social converse. The patient is entitled 
to the best skill of the doctor and nurse and should 
receive their undivided attention. There are always 
in the hospital and elsewhere those who are ready to 
criticise; and it must be remembered that as a rule 
their criticism is not of the individual nurse, but of 
the whole nursing profession. 

Respect for Officers.— The etiquette of the 
army is repeated in the hospital, and it is insisted 
upon there for the same reason as in the army 
"Familiarity breeds contempt.'' We rarely obtain 
unquestioning, prompt, obedience from those with 
whom we are too familiar, and we respect less the 
judgment and the decision of our superiors if they 
are familiar with us. Xurses are. therefore, required 
to stand when speaking to those in command and to 
give precedence at all times not only to the doctor 
and to their officers, but also to their seniors in the 
school. The members of the senior class should not 
be on too friendly terms with their juniors, for they 
may at any time be placed in charge of wards or in 
other positions of authority over them. 

Respect for the Secrets of Others. — When 
people are ill and in trouble they are very liable to 
tell things which in calmer moments they would never 
think of mentioning. Too much stress cannot be laid 
upon the importance of keeping such secrets inviolable. 
The nature of our patients' ailments should also be 
a matter of trust. In fact, the safest and most 



12 Practical Nursing 

honourable course is never to discuss patients in any 
way. Many a nurse has had cause to bitterly regret 
a few careless words about the person under her 
care, or being drawn into a discussion of former 
patients and their ailments. 

If nurses would follow more closely the principles 
of the Florence Nightingale Pledge, which is given 
below and which is recommended to their attention, 
they would be less likely to commit many of the 
indiscretions for which they are often justly blamed. 

The Florence Nightingale Pledge . — " I solemnly 
pledge myself before God and in the presence of this 
assembly to pass my life in purity and to practise 
my profession faithfully. I will abstain from what- 
ever is deleterious and mischievous, and will not take 
or knowingly administer any harmful drug. I will 
do all in my power to maintain and elevate the stand- 
ard of my profession and will hold in confidence all 
personal matters committed to my keeping, and all 
family affairs coming to my knowledge in the practice 
of my calling. With loyalty will I endeavour to aid 
the physician in his work, and devote myself to the 
welfare of those committed to my care. " 



CHAPTER II 

BACTERIOLOGY 

Important Facts in the History of Bacteriology: Prepara- 
tion of Culture Media — Making Cultures. The Xature and 
Classification of Bacteria: Where Bacteria are Found. 
Methods of Destroying Germs: Disinfectants and Anti- 
septics. Rules to be Followed in Making Solutions. 

ALL measures for the prevention of disease are 
based on bacteriology. Hence, the study of 
this subject should be taken up early by persons who 
are being prepared to care for the sick. Indeed, 
there is no other way by which such a realisation of 
the existence of microscopical organisms, as will 
insure scrupulous obedience to the laws of asepsis 
and prophylaxis, can be obtained. 

Important Facts in the History of Bacteriology 

The minute organisms now known as bacteria (or 
germs) were first seen and described by Antony van 
Leeuwenhoek in the year 1675, but neither Leeuwen- 
hoek nor several generations of his successors, owing 
to the inefficiency of their microscopes, were able to 
gain sufficient knowledge of these "animalcules," 1 
as they then called these organisms, to be of any practi- 
cal benefit. 

1 Their power of motility led Leeuwenhoek and many of 
his successors to believe that bacteria belonged to the animal 
kingdom. 

13 



H Practical Nursing 

In 1749, Needham and Liebig, Dutch chemists, 
declared that germs developed spontaneously, as the 
result of chemical change. 

In 1762, Marcus Antonius Plenciz, a physician of 
Vienna, claimed a special germ for each disease and 
taught the probability of the multiplication of germs 
within the body and their transmissibility through 
the air. 

In 1769, Spallanzani refuted Needham's teachings, 
showing that if infusions of decomposable vegetable 
matter were put into air-tight flasks, and these flasks 
were allowed to remain for some time in a vessel of 
boiling water, putrefaction was arrested. 

In 1 86 1, Louis Pasteur, of France, proved beyond 
doubt that germs come into existence by reproduction, 
and not by spontaneous generation. He also estab- 
lished the validity of Plenciz' s theory regarding the 
cause and transmission of disease, and suggested 
th it all putrefaction, the souring of milk, the fermen- 
tation of sugar, and like processes were due, and due 
solely, to the work of germs. 

In 1869, Hoffman commenced the classification 
of these organisms. It is only since his day that 
the term "bacteria" has been used. 

Pasteur and Hoffman were much handicapped 
in their work by lack of proper culture media, in 
which to develop and study the germs. It was Robert 
Koch, who, in 1881, overcame this obstacle. He 
noticed that separate colonies or groups of bacteria 
appeared on the surface of potatoes or bread which 
had been exposed to the air for some time, and that 
these different colonies never became confluent. He 
also noticed that a scum appeared on the top of 
bouillon under the same conditions. Wishing to see 



Bacteriology 



if separate colonies would form in the bouillon if it 
was solid, he added liquefied gelatine to it. Several 
modifications have since been made in the culture 
media of Koch, but the bases remain the same to this 
day. 1 

Lord Lister, in 1876, was the first surgeon to put 
Pasteur's and Hoffman's discoveries to practical use. 
He soaked his instruments and dressings in carbolic, 
1-40, and kept a carbolic spray, 1-20, playing con- 
stantly near the operating table while he worked. 
Later researches have shown that the spray was a 
mistake, it being impossible to disinfect air in such 
a manner, and that carbolic is an inefficient disin- 
fectant for dressings and instruments. But Lister's 
attempts at asepsis, imperfect as they were, gave a 
decided impetus to bacteriological research. 

Preparation of Culture Media. Making Cul- 
tures for Tests. — Though it is not necessary for 
nurses to be able to differentiate bacteria, it is inter- 
esting and often exceedingly useful for them to have 
at least a slight idea of the laboratory method em- 
ployed in the preparation of media 2 and in making 
cultures for tests. 

Bouillon for Culture Media. — To make bouillon 
for culture media, chop finely one pound of beef, put 
it in a clean vessel, and add one litre of distilled water. 
Mix well, cover, and put in a refrigerator for twenty- 
four hours. Strain through a clean towel, and press 
until one litre of fluid is obtained. Add ten grammes 
of peptone and five grammes of common salt. Then 

1 Media are preparations in which germs will thrive, and a 
culture the propagation of bacteria in or on such prepara- 
tions. 

2 For a detailed account of these media, see page 000. 



1 6 Practical Nursing 

place over a free flame to boil for half an hour. 
Finally filter through filter-paper and neutralise by 
adding a few drops of a solution of caustic soda. 

If solid media are wanted, add either gelatine in 
the proportion of 10 to 12% or agar-agar. 1 The 
latter will stand a higher temperature than the 
former without becoming liquefied. 

Loefrler's blood serum in which many species of 
bacteria thrive better than in any other kind of 
media is also much used in laboratories. To prepare 
this serum, the blood which is obtained from the 
slaughter-house should be collected in sterile jars, 
tightly covered, and allowed to stand about half an 
hour, until clotting has begun. It should then be 
put on ice for twenty-four hours, at the end of which 
time the serum should be poured off into sterile 
glasses. Glucose bouillon should then be added in 
the proportion of one part of bouillon to three parts 
of serum. Transfer this to sterile test-tubes; place 
these in a slanting position in a steriliser; and heat 
until solidified. 

To Test Sponges, Dressings, etc, with a View 
to Discovering Germs. — To detect the germs in 
sponges, dressings, etc., put a small piece of the 
material to be tested into a tube of bouillon, taking 
care that it comes in contact with nothing unsterile 2 
in the process, and that the sterile end of the plug 3 
does not touch the rim of the test-tube either when 

*A sea- weed found on the coast of Japan and China. 

2 It must be remembered in making tests that to obtain 
pure cultures, all the utensils used must be perfectly sterile. 

3 Sterile non-absorbent cotton being impervious to air 
makes the best stopper when wishing to keep the contents of 
a bottle or test-tube sterile. 



Bacteriology 



i 



it is being removed or reinserted. Place the test 
tube where it will be in the dark and in a temperature 
of 90 to 98 F. If at the end of twenty-four hours 
the bouillon is still clear, the article therein is sterile; 
if the bouillon has become cloudy, the reverse is 
indicated. 

To discover the nature of the germs which have 
caused the clouding of the bouillon, sterilise a plati- 
num loop in the flame of a Bunsen burner, take up a 
loopful of the bouillon culture, and mix with a tube 
of liquefied gelatine or agar-agar. In order to pro- 
cure some culture containing a smaller number of 
organisms, transfer a loopful of the mixture to a 
second tube, and then a similar amount from the 
second tube to a third tube. Pour these mixtures, 
each into a sterile Petri dish, cover quickly, and set 
aside. After twenty-four hours, colonies 1 of bacteria 
will have developed, and, each kind having been able 
to grow in its own typical way, the different colonies 
may be picked out and studied. 2 

To study the bacteria it is best to stain them. To 
do this make a cover-glass preparation by taking a 
clean cover-glass and placing a small drop of sterile 
water upon it with a sterile platinum needle. Then 
mix carefully with the drop of water a very small 
portion of a colony until the mixture is spread like a 
thin film over the cover-glass. Allow this to dry in 
the air. When it is dry, take up the glass with a 
pair of forceps and fix the culture by passing it through 

1 Each clump of bacteria in the gelatine is called a colony. 

2 It need hardly be said, that in hospitals it is constantly 
necessary to make tests of sponges, dressings, etc., with a 
view to ascertaining whether they contain bacteria and if so 
of what kind. 



1 8 Practical Nursing 

the flame of a Bunsen burner three times. Pour on 
the film a few drops of fuchsin or methylene blue, 
allowing it to remain about half a minute, rinse the 
film in water, dry between blotting-paper, put a drop 
of balsam 1 in the centre with the sterile platinum 
needle, 2 and place a cover-glass over it. The culture 
will then be ready to be examined under the micro- 
scope. 

When the object to be tested cannot be put into 
bouillon, rub a sterile swab 3 over its surface, and then 
rub the swab on some sterile, solidified gelatine in a 
properly plugged test-tube. If the object is not 
sterile, the tube will show a growth of bacteria within 
twenty-four hours. Prepare this for examination in 
the same manner as the growth from the bouillon. 

Some bacteria possess certain idiosyncrasies by 
which they may be distinguished. Thus many of 
them are coloured — yellow, lemon, orange, red, grey, 
etc. — and are called chromogenic. Some germs 
liquefy the culture media. Some liberate certain 
gases. Some — aerobic bacteria — need oxygen for 
their subsistence, while others — anaerobic bacteria — 
do not. 

Another important characteristic of bacteria is 
their capacity for being stained. Owing to this 
property, it has been found possible, by the use of 
various dyes and decolourising agents, to differentiate 
between many similar bacteria. For example, tuber- 
cle bacilli when stained with methylene blue, appear 

1 The sole use of the balsam is to keep the cover-glass 
fixed to the slide. 

2 The needle is sterilised each time it is needed by being 
passed through the flame of a Bunsen burner. 

3 Cotton rolled upon a stick. 



Bacteriology 1 9 

blue like other bacilli to which methylene blue has 
been applied. But if they are stained with carbol 
fuchsin and then treated with nitric acid and alco- 
hol, they persist a brilliant red, while most other 
bacilli when subjected to these same conditions are 
decolourised. 

The Nature and Classification of Bacteria 

Bacteria are the smallest organisms known. They 
consist of cells of protoplasm encased in cellular sacks. 
The power of independent motion possessed by many 
of them, and their ability to assimilate complex 
bodies as food caused much indecision formerly as to 
their nature; but their general shape, their method of 
growth, and their tendency to form threads and spores 
have finally led the scientists to classify them as 
vegetables. In many ways they are similar to the 
ocillaria, a low form of plant life which lacks 
chlorophyl. 1 

All bacteria are not harmful. It is by their agency 
that decomposition takes place, and the chemical 
changes that they produce through decomposition are 
necessary not only to plant life, but to the preparation 
of much of our own food, and to the carrying on of 
many of our industries. 

Germs are divided, according to the results they 
produce in a substance which has been inoculated 
with them, into three distinct classes: those causing 
suppuration in wounds; those producing disease (see 
Chapter XXIII) ; and those causing change in food 
and like material (see Chapter XXIV). 

^he green colouring matter of plants which enables them 
to decompose carbonic acid and ammonia into their elemen- 
tary constituents. 



20 Practical Nursing 

The germs which do not produce disease are called 
non-pathogenic. They are: 

The moulds, or hyphomycetes; 

The yeasts, or blastomycetes; 

The saprophytes, or bacteria which produce putre- 
faction ; 

The schizomycetes, or bacteria which cause fer- 
mentation. 

The pathogenic bacteria are those which pro- 
duce morbid changes in wounds and those which 
cause disease. The former gain entrance to the body 
through breaks in the skin and mucous membranes, 
the majority of the latter through the respiratory 
and alimentary tracts. 

Although there are hundreds of varieties of bacteria, 
they vary but little in shape, being mostly either 
spheroidal, ovoidal, rod-shaped, or spiral. The 
spheroidal measure -giW °f an inch in diameter, the 
ovoidal Y^do- of an inch in diameter, and the spiral 
and rod-shaped yo * o6 - of an inch in length. 

The spheroidal and ovoidal are called cocci (singular, 
coccus) ; the rod-shaped, bacilli (singular, bacillus) ; 
and the spiral, or corkscrew, spirilli (singular, spiril- 
lum). 

There are several subdivisions of the cocci, based 
upon their manner of grouping themselves: 

i. When single they are called micrococci. 

2. When in pairs, diplococci. 

3. When in clusters like a bunch of grapes, staphy- 
lococci. 

4. When in a chain, streptococci. 

5. When in an irregular mass, in a gelatinous mat- 
rix, zooglia. 

6. When in eights or sixteens, sarcina. 



Bacteriology 2 1 

Germs Causing Morbid Processes in Wounds. — 
The most important bacteria to be considered in 
surgery are: 

1. Staphylococcus pyogenes aureus, a very preva- 
lent pus-producing micro-organism, nearly always 
present in the dust of surgical wards. It is generally 
present also in large numbers in suppurating wounds. 

2. Streptococcus pyogenes, another and more 
virulent pus-producing germ, which is a common 
cause of septicaemia and post-operative peritonitis. 

3. Bacillus coli communis, which always exists in 
the intestine, but which exists there in increased 
numbers in almost any intestinal disease and especi- 
ally in peritonitis. 

4. The bacillus of tetanus which is found especially 
in the soil, on rusty metal, and in and around unclean 
stables and cellars (see Chapter XXII J. 

5. The streptococcus of erysipelas which produces 
erysipelas, a very serious complication when occurring 
in wounds. 

6. The diphtheria bacillus which is not only a 
disease-producing germ, but which will also cause a 
virulent and often fatal complication if it enters a 
wound. 

Where Bacteria are Found. These, though the 
most prevalent, are only a few of the many germs 
that may cause troublesome, if not fatal, complica- 
tions in wounds. They are almost omnipresent, 
as are the germs producing disease (see Chap- 
ter XXIII. Contagious Diseases) and the many harm- 
less and useful germs. They are in the air, 
though decreasing in the upper strata. They are in 
the ocean to a considerable depth ; in all running and 
standing water, particularly in the latter; and in the 



22 Practical Nursing 

soil, to the depth of four or five feet. The dust also 
is full of them. They are in our mouths, in our hair, 
under our nails, and in the glands of the skin. The 
glands and the internal organs of our bodies with 
the exception of the intestines are, in health, 
generally free from bacteria, but bacteria are present 
in all the ducts and passages leading to them. There 
is naturally no place where germs are more prevalent 
than in the wards of a hospital, therefore greater 
pains must be taken there to guard against their in- 
vasion, and to secure their destruction. 

Manner of Growth of Bacteria 

Bacteria multiply w4th great rapidity. One bac- 
terium will multiply 16,500,000' times in twenty-four 
hours. That bacteria do not overrun the world is 
due to two facts: first, they require favourable con- 
ditions for development ; and, second, they soon 
liberate, by their excessive multiplication, toxic 
material which not only checks their increase, but kills 
many that already exist. It was the discovery of 
this toxic material that led to the trial of antitoxines. 

The following are the methods by which bacteria 
reproduce themselves: 

The yeasts and moulds divide by budding; that is, 
small nodules appear on their surface, which, breaking 
off, form independent organisms. 

The bacteria proper multiply by fission; that is, 
they become elongated, and the elongation, dividing, 
forms a new bacterium. 

The conditions favouring the growth of germs vary 
with different species; the different requirements of 
the respective species are one of the means of recog- 



Bacteriology 23 

nising the species. All need moisture, freedom from 
the direct rays of the sun, food (the kind depending 
on their nature), 1 and warmth (85 to 105 F, 
according to the species. 

Spores. — Spore formation is the process by which 
certain bacteria are enabled to enter a state in which 
they are more resistent to external influences. Spores 
are seen as round, or ovoid highly refracting bodies in 
the bacteria. These are eventually thrown off, and 
under favourable conditions, develop into bacterial 
forms. Some germs have not the power of forming 
spores, and such are easily destroyed. 

Methods of Destroying Germs 

Two most effectual means of killing bacteria 
are (1) heat, and (2) disinfectants or germicides. 
Scrupulous cleanliness, it is hardly necessary to 
say, is an indispensable assistant. Freezing will 
not destroy all germs. Cold is only an antiseptic. 
It arrests the development of germs, but, so soon 
as a favourable temperature is restored, they will 
be as active as ever. The use of heat to destroy 
germs is called sterilisation; the use of chemicals 
is called disinfection. 

Sterilisation. — There are four methods of sterili- 
sation by heat: 

1. By boiling. 

2. By the use of live steam. 

3. By the use of live steam under pressure. 

4. By hot air, or dry sterilisation. 

Boiling. — When the articles to be sterilised are of 
metal with a perfectly plain surface, such as scalpels 

1 Slightly alkaline proteid material, either inside or outside 
the body, suits the nature of the greater number. 



24 Practical Nursing 

and needles, 1 thirty seconds is a sufficient length of 
time to expose them 2 to the influence of boiling. 
When there are grooves or joints, or when the object 
is of thin rubber, 3 such as rubber gloves, catheters, 
rectal tubes or rubber tubing, three to five minutes 
are necessary. When the article is absorbent, 
twenty to thirty minutes, according to its thickness, 
is required. Water, to be sufficiently sterile for surgi- 
cal purposes, should be boiled for twenty minutes; 
oil, for half an hour. 

Steam. — When sterilising articles by steam, not 
under pressure, it is necessary to expose them to its 
influence on three successive days, for one hour 
each day. The maximum temperature of steam, not 
under pressure, ioo°C, though sufficient to kill 
bacteria, is not sufficient to destroy the spores, into 
which all the bacteria that have the time and power 
are transformed during the steaming. These spores 
become bacteria again, as soon as the temperature 
is sufficiently lowered. Consequently, it takes several 
steamings to destroy them all. To favour the develop- 
ment of the spores keep the articles being sterilised 
in a temperature of about 8o°F., between the suc- 
cessive steamings. If the articles are to be used for 
surgical purposes, wrap them, before beginning 

1 To prevent rusting boil in a i % solution of soda. 

2 As these instruments easily become blunted, they should 
not be left in longer; they should not be put in, until the 
water is boiling; their points should be protected by rolling 
in gauze or absorbent cotton, and they should be placed 
in the steriliser blunt end foremost. The wires must be 
taken out of needles before sterilisation. 

3 Salt (3 i to a litre) should be put in the water in which 
rubber goods are boiled, to prevent them from softening. 



Bacteriology 25 

sterilisation, in a thick covering and keep in a scru- 
pulously clean receptacle between and after the 
steamings. 

The Arnold steriliser is the apparatus most fre- 
quently used, in the hospital, for this method of 
sterilisation. In private practice, however, an ordi- 
nary vegetable or fish-steamer may be substituted 
for it. If the bundle being sterilised becomes very 
wet in the process, dry it in a warm oven. 

Steam under Pressure. — A much greater degree 
of heat being possible in an apparatus where the 
steam can be obtained under pressure, one sterili- 
sation is sufficient. In the larger hospitals, steam 
under pressure is commonly used in the preparation 
of sterile surgical dressings, sterile solutions, etc. 
These objects are exposed to steam at a 15-pound 
pressure, temperature 250 F., for half an hour. 

Dry Sterilisation. — Dry sterilisation is now little 
used, except in laboratories, for culture tubes and other 
glassware. If this process is to be of any benefit, the 
articles must be exposed for one hour to a tempera- 
ture of 300 to 324°F., and very few materials will 
stand this high degree of heat without deteriorating. 

Steam, being more penetrating, will be more effec- 
tual in twenty minutes, than dry air at 3oo°F., in an 
hour. 

Disinfection. — When it is impossible to apply 
heat for the purpose of killing germs, chemicals are 
resorted to. These chemicals are called disinfectants 
or germicides. 

The Disinfectants. — There are a great variety of 
disinfectants in use already and new ones are con- 
stantly being discovered. Some of the disinfectants 
in most common use are; 



26 Practical Nursing 

Alcohol. — Alcohol 70% * is a disinfectant for spore- 
less organisms. The solvent action which it and 
ether (ether is not a disinfectant) have on fatty 
matter make them invaluable for cleansing not 
only the skin, but also the utensils, instruments, 
sutures, ligatures, etc., used for surgical purposes. 

Bichloride of Mercury (Corrosive Sublimate). — To 
be thoroughly disinfected, articles must be soaked in 
bichloride, 1-1000, for twenty minutes; in 1-5000, 
for an hour. Bichloride will discolour clothing, and 
corrode metal, marble, porcelain, and wood, so it 
must not be used for their disinfection. It is a 
valuable disinfectant for the skin and for glass utensils. 
It was formerly much used in the disinfection of 
excreta, but it has been lately demonstrated that, 
as it hardens albuminous matter, it forms a coating 
over certain masses which makes them impervious 
to the solution, thus lessening its action. It is some- 
times used for irrigating infected wounds, and for 
disinfecting the mouths of patients suffering from 
germ-diseases, in a strength of 1-10,000. 

The compressed tablet is the most convenient 
form of bichloride for use in private practice. One 
tablet dissolved in a pint of water will make a 1-1000 
solution. In hospitals, for economy's sake, the 
solution is made directly from the powder. Such 
great accuracy is required in the measuring that this 
is done, as a rule, in the pharmacy, the wards being 
provided with solutions of either 1-10 or 1-20 from 
which the weaker solutions can be made, as required 

1 Some authorities consider 70% a more efficient disinfect- 
ant than absolute alcohol. They hold that the latter by 
coagulating any albuminous substance in which the germs 
may be, limits its action. 



Bacteriology 



(see rules for diluting solutions, page 32). When 
dissolving the powder, a small quantity of salt and 
tartaric, or other harmless acid is added to the 
bichloride. The salt makes the bichloride soluble 
in a smaller amount of water. The tartaric acid 
neutralises its action on albuminous matter, and 
thus prevents it from precipitating the albuminous 
secretions of the skin, which blacken and otherwise 
injure the hands. 

Bichloride solutions should only be used when 
fresh, as they are converted, by standing, into 
insoluble calomel which is not germicidal. 

Carbolic Acid. — A solution of carbolic acid 1-20 
if brought in direct contact with sporeless organisms 
will kill them in a few minutes. A 1-120 solution 
is sometimes used for vaginal douching; in that 
strength it is only antiseptic. 

Carbolic will not discolour white materials nor 
metals, so it is often used in their disinfection. 

Except for hospital use, when the crystals are 
bought, carbolic acid is generally purchased in a 
95% solution, and diluted, as required. In this 
strength, it is a violent corrosive, and care must be 
taken not to spill any over the hands or upon the 
skin. If this should happen, the action can be 
neutralised by the immediate use of alcohol. 

Carbolic can be diluted with either cold or hot 
water. It must be shaken until all globules disappear, 
as these will burn any tissue with which they come 
in contact. 

Lysol. — Lysol, a coal-tar derivative, is equal in 
strength to carbolic. It is often added to vaginal 
douches. It is used in solutions of from 5 to 10%. 
It is sometimes employed for disinfecting utensils, 



28 Practical Nursing 

but is expensive, if used in sufficient strength to be of 
any value. 

Chlorinated Lime. — Chlorinated lime is principally 
used for disinfecting excreta, water-closets, sinks, and 
hoppers. It is only good when perfectly fresh. To 
ascertain if it is fresh, dissolve a little in water; if 
the water becomes turbid, the lime is stale. 

Milk of Lime. — Milk of lime is used for the same 
purpose. It is made by adding one part of slaked 
lime to four of water. 

Chlorinated Soda (Labarr aqite' s Solution). — Chlorin- 
ated soda is a French preparation, which is excellent 
for removing stains from glass and porcelain utensils, 
dressing rubbers, etc. Owing to its pungent odour, 
irritating effect on the skin, and deteriorating effect 
on clothing, it is only useful as a disinfectant for 
water-closets, sinks, bed-pans, and the like. It is 
very useful for these purposes, however, since, by 
liberating chlorine gas, it acts as a deodoriser as 
well as a disinfectant. 

Creoline. — Creoline is used as a disinfectant and 
deodorant for suppurating and offensive wounds, in 
solutions of from 2 to 5%. In diluting creoline, the 
water should always be poured into the flask before 
the creoline. The water must never exceed 98°F., 
or the drug will be too thoroughly dissolved, and its 
action will be lessened. Creoline exposed in an open 
dish is slightly deodorant. 

Formaldehyde. — Formaldehyde, a gaseous solution 
formed by the partial oxidation of wood alcohol, 
is rapidly superseding the above-mentioned disin- 
fectants for the majority of purposes, and especially 
for the disinfection of clothing and utensils. Its 
action is quicker than that of carbolic, and less 



Bacteriology 29 

limited than that of bichloride. Its pungent odour 
and its irritating effect on the throat and nose of 
the person using it are the only objections to it. 
It does not discolour metal, and a 2% solution will 
be effectual in thirty minutes. The fumes are used 
for disinfecting rooms (directions for fumigation will be 
found in Chapter XXIII.) after contagious diseases. 
Mattresses, blankets, coloured clothing, metal, leather 
goods, and wall papers can all be exposed to these 
fumes without injury. 

The gas is generated either from cones of com- 
pressed powdered formaldehyde, lighted as a candle, 
or by different varieties of specially devised appara- 
tus. Some of the latter produce nascent formal- 
dehyde directly from the wood alcohol, by oxidation; 
others liberate the gas from tablets of compressed 
formaldehyde, which are placed in a small compart- 
ment directly above a flame. Formaldehyde is also 
an excellent deodorant. 

Another method of liberating gas from formalde- 
hyde is to add crystals of permanganate to a 4% 
solution of formalin in the proportion of one to four. 
One pint of formalin will be sufficient to disinfect a 
room 2,000 cubic square feet. The solution must be 
put in a five gallon pail, and the floor under it well 
protected, as the solution boils violently immediately 
upon the addition of the crystals. 

Potassium Permanganate. — Potassium permangan- 
ate is generally classed as a disinfectant, though by 
many it is considered only antiseptic. Some sur- 
geons consider it a fairly good skin disinfectant, if 
used in a supersaturated solution and in conjunction 
with oxalic acid. The oxalic not only helps in the 
disinfection, but removes the stains made by the 



30 Practical Nursing 

permanganate. Care must be taken in using per- 
manganate, as it makes almost indelible stains on 
linen, wood, and other absorbent material. 

Oxalic Acid. — Oxalic acid is used as a disinfectant 
in connection with potassium permanganate. 

The Antiseptics. — The chemicals which will not 
destroy germs but which will retard their growth and 
check their action are called antiseptics. The more 
important antiseptics are: 

Boric Acid. — Boric acid is used for bladder, eye, 
and nasal irrigations, and for mouth washes, generally 
in 2 and 4% solutions. It is cheaper to buy it in 
powder form and make the solution oneself than to 
buy the solution. The solution is made by dis- 
solving the powder in hot water. Standing the 
bottle or flask in a saucepan of boiling water will 
assist in dissolving the powder. When boric acid is 
used for bladder irrigation it must be sterilised. 

Peroxide of Hydrogen. — Peroxide of hydrogen is 
valuable in the cleansing of infected wounds. The 
active effervescence which takes place as soon as it 
is poured into a wound carries off morbid and sup- 
purating tissue. It is also used to control oozing of 
blood from capillaries. 

Salt Solution. — Normal salt solution, though pos- 
sessed of only slight antiseptic properties is much 
used, on account of its stimulating effect on tissue, 
in the cleansing of wounds, bladder irrigations, and 
vaginal douches. Being of the same alkalinity as the 
blood, and mixing well with the same, it has almost 
entirely superseded other stimulants for hypodermo- 
clysis, intravenous infusions, and rectal irrigations 
(when given for stimulation). When employed for 
wounds, it must be sterilised; when intended for 



Bacteriology 3 1 

hypodermoclysis and intravenous infusions, both 
filtered and sterilised Normal salt solution is so 
called because it contains about the same amount of 
salt as the blood serum. Formerly, j% of a i% 
solution was considered the correct percentage, and 
it is still often used as such, though it has been 
lately proven that f$ of i% is accurate. 

To make one litre of a i% solution, dissolve 6 
grammes of salt in one litre of water. To filter 
it, place a funnel, with a piece of absorbent cotton 
in the bottom, in the neck of an empty flask or bottle, 
line the funnel with filter-paper, and then pour the 
salt solution in, a small amount at a time, allowing 
it to filter slowly through. When preparing the 
solution for subcutaneous use, refilter it until it is 
perfectly clear. Seven or eight filterings are usually 
necessary. When the filtering is finished, make a 
large, sterile non-absorbent cotton plug for the flask, 
or bottle and bandage it in place. This not only 
provides a germ-proof stopper, but keeps the rim 
of the flask free from dust. The solution is best 
sterilised by steam under pressure. If steam without 
pressure is used, the sterilisation must be repeated, 
as in the case of dressings, three successive days. 
In an emergency, the sterilisation can be done by 
placing the flask in a kettle of water, and letting it 
remain there half an hour after the solution has been 
brought to the boiling point. The flask should never 
touch the bottom of the kettle, however, for it may 
break. This may be prevented by placing under it a 
pad made of a few thicknesses of old muslin or gauze. 

Rules to be Followed in Making Solutions 

t . To estimate the amount of drug necessary for a 



32 Practical Nursing 

solution of a specified percentage, reduce the amount 
of solution required to minims, multiply by the rate 
per cent., and point off two places. Thus it would 
require 614 grams or one ounce and 12 grams of 
boric acid powder to make one quart of a 4% solution 
of boric acid ; and 3 drachms and 1 2 minims to make 
one quart of 2% creoline from the crude drug. 

2. To estimate the amount of drug to be used when 
a given number of parts of the solution are to contain 
one part of the drug, reduce the amount of solution 
required to minims, and divide by the number of 
parts to contain one part. Thus, it would require 
765 grains of bichloride powder to make one quart 
of a solution, 1-20. 

3. To make a weaker from a stronger solution, 
divide the weaker by the stronger solution, use the 
result as the divisor, and the number of cubic centi- 
metres required as the quotient; thus since there are 
1000 c.c. in one litre, it will require 20 c.c. to make 
one litre of bichloride 1-1000, from a 1-20 solution. 



CHAPTER III 

VENTILATION 

Methods of Ventilation. Heating. Prevention of Air Con- 
tamination by Proper Care of Utensils, Sinks, Hoppers, etc. 

A PLENTIFUL supply of fresh air is an important 
factor in the treatment of disease. It is a well- 
known fact that soldiers cared for in open tents, in 
time of Avar, have recovered under the most adverse 
circumstances, when food, medicine, and nursing have 
all been most meagre. This result has been credited 
to the great quantity of fresh air and sunlight with 
which they were unavoidably provided, and of which 
patients in hospitals and sick-rooms, where everything 
else is furnished in abundance, are too often deprived. 
The gradual realisation of the curative properties of 
fresh air and sunlight is leading, year by year, to the 
opening of new sanitoria specially equipped for open- 
air treatment, and to the addition to hospitals of 
sun-rooms and rooms connecting with wide verandas 
so arranged that the beds can be wheeled through 
the window. 

In cities the roofs of hospitals and dwelling houses 
are being utilised for this purpose. 

The average composition of air, as it is inhaled, is: 
oxygen, 2o.8"i ; nitrogen, 79.45; carbonic acid, 0.04; 
a small amount of aqueous vapour; and a gaseous 
element named argon, about which little is known. 



34 Practical Nursing 

The proportion of oxygen and carbonic acid in the 
air varies considerably according to locality. In the 
country, there will be more oxygen and less carbonic 
acid than the above figures indicate, and in thickly 
populated cities, more carbonic acid and less oxygen. 

Air which has been inhaled, deprived of as much 
of its oxygen as the lungs can absorb, and then ex- 
haled, consists of: oxygen, 16.033; nitrogen, 79.587; 
carbonic acid, 4.38; and a larger amount of aqueous 
vapour, impregnated with impurities from the lungs. 
Both these impurities and the carbonic acid are 
much increased by illness. 

Other factors, besides the breath, which contami- 
nate the air are the exhalations given off by the skin, 
the excreta, decaying matter, dust, and combustion- 
A single burner of illuminating gas consumes as much 
oxygen as three people, and liberates sulphur dioxide, 
carbon monoxide, carbon dioxide, ammonium com- 
pounds, and aqueous vapour. The products freed in 
the burning of oil lamps and candles are somewhat 
less in amount and importance. Incandescent electric 
lights, requiring no oxygen and producing no decom- 
position, are, so far as ventilation is concerned, the 
most healthful method of lighting. 

With every inspiration, from twenty to thirty 
cubic inches of air are drawn into the lungs, and with 
every expiration almost the same amount is expelled. 
If a patient and nurse are shut up in a room, even a fair- 
sized one, a whole night, at least half the air in the 
room will pass through their lungs before morning. 
The patient, being deprived of sufficient oxygen, the 
great energy-giver, will lose much that would have 
accelerated his recovery, and the nurse will be rend- 
ered tired and unfit for her work by the same cause. 



Ventilation 35 

If the proportion of oxygen in the air falls to 13% 
ill effects are instantly felt, and if it falls to 8%, 
asphyxia will shortly occur. 

A constant supply of "pure, 1 fresh, flowing air" 2 
is essential to health. It is imperative in hospital 
wards, where there are generally from twenty to 
thirty patients, and where, frequently, the beds are 
not placed far enough apart to give each patient his 
proper air-space, viz. : at least 2000 cubic feet. 

Out of doors the three principal renovators and 
regulators of the atmosphere are the winds, the rain, 
and growing plants. Plants are a valuable adjunct 
in sick-rooms and hospital wards, because they take 
up carbon dioxide and set oxygen free. The same 
is true of cut flowers while they are perfectly fresh; 
but, as soon as they begin to fade their oxygen-giving 
power is lost, for carbonic acid is always liberated 
in decomposition. 

Gravity and diffusion are the two forces that render 
indoor ventilation possible. Even a small amount 
of cold air from the outside will fall, as it enters a 
room, because it is heavier than the air in the room, 
and it will drive up and out the air which, by being 
heated, has become lighter. Heat, besides making 
the air lighter, causes it to expand and thus compels 
it to find an exit through every available crack and 
outlet. Ventilation procured by means of these 
natural forces is known as "natural ventilation." 

1 Always be sure of the source of your fresh air. It will 
not be pure if it come through a window facing a stable, 
garbage heap, a crowded tenement, or a court contaminated 
by decomposing material. 

2 To secure perfect ventilation, the air must be kept in 
motion, or flowing, but its movement should not be felt by 
the people in the room. When it is felt it is called a draught. 



36 Practical Nursing 

Ventilation must be carried on continually, day 
and night. To ventilate a room well in cold weather 
and yet avoid draughts, the air should be admitted 
from the top. When it has double windows this is 
easily arranged; the lower sash of the outer window 
may be raised and the upper sash of the inner window 
lowered. When it has only single windows, the lower 
sash may be raised three or four inches and a board 
inserted in the opening. The air then enters between 
the sashes, and, being thus directed upwards, causes 
the necessary air currents without creating a draught. 
Another method of ventilating with single windows 
is to lower slightly the upper sash and tack one end of a 
piece of cotton 1 to its upper edge and the two corners 
of the other end to the top of the window frame. 

An open fire is one of the best ventilators. Air 
being always attracted toward heat, the air in the 
room is drawn into the fireplace and then up the 
chimney. Thus a vacuum is created which sucks in 
the outside air from all available sources. To avoid 
dirt, noise, or too much heat, a lighted lamp is often 
substituted in the fireplace for the fire. 

This slight continual ventilation of the sick-room 
should be supplemented by flushing it with air at least 
every morning and evening. To do this without 
danger to the patient, put extra blankets over him, 
leaving only his face exposed. If the bed is near 
the window, place a screen between the two. 2 W nile 
the window is open, encourage the patient to take 
as many deep, long inspirations as he can without 

i The cotton may be any length desired, but should be six 
inches wider than the window. 

2 An open umbrella is an excellent substitute, when there 
is no screen at hand. 



Ventilation 37 

becoming tired. If the weather is too cold to permit 
opening the window of the sick-room, or the nature 
of the patient's disease demands an even temperature, 
open a window in an adjoining well-heated room, and 
leave the door between the rooms ajar. If even this 
cools the air too suddenly, keep the door between the 
rooms shut until you have closed the windows in the 
outer room and allowed the air there to become heated 
before admitting it to the sick-room. 

Do not forget that sunlight is necessary to perfect 
ventilation. There are few cases except eye-affec- 
tions, in which this natural germ-destroyer should be 
excluded from the sick-room or ward. If the light 
hurts the patient's eyes, encourage the wearing of 
a shade, or put a screen between him and the direct 
rays of the sun. 

In cold countries, the majority of the hospitals 
are ventilated by mechanical means. When they 
are not, a sufficient number of windows are opened 
to keep the air pure. 

Mechanical ventilation consists in the propulsion 
or the extraction of air, by means of blowers or of 
exhaust fans, driven by steam or electricity. The 
propulsive method is known as the plenum system, 
and the extractive method as the vacuum system. 

Even when these mechanical means of ventilation 
are employed, the nurse is responsible for the con- 
dition of the air in the wards, or sick-room. If the 
air becomes heavy and full of odours, the ventilators 
are either not open, or they are not working properly, 1 
and the fact should be reported to the proper author- 

1 To test the output of the air, hold an opened handkerchief 
in front of the ventilator; if it is working properly the hand- 
kerchief will be sucked up against it. 



38 Practical Nursing 

ities. If the temperature of the ward cannot be 
governed by the local regulator, this fact should also 
be reported. Wards and sick-rooms should be kept 
at a uniform temperature; 68°-7o°F., in the day time, 
and 65°-68° F., at night, has been until lately a 
general rule, but a much lower temperature is now 
advocated by many physicians. 1 

To insure the regulation of the ward-heat, the 
majority of hospitals now provide charts closely 
resembling the clinical temperature charts used for 
recording the patients' temperatures. One nurse is 
made responsible for taking and charting the ward 
temperature every hour. Nurses should feel pride 
in having these charts perfect. If there are many 
vacant spaces, the authorities are liable to wonder 
how often the nurse, responsible for the same, forgot 
her patients' medicines and treatments. It is also 
important to regulate the temperature after taking 
and charting it. A temperature of 8o° is sometimes 
charted apparently unnoticed. 

To obtain perfect ventilation, it is not only necessary 
that the heating be well regulated and the supply of 
air constantly changed, but that the air be kept, so 
far as is possible, free from contamination. To this 
end every effort must be made to keep the patients 
and whatever relates to them perfectly clean. 

The exudations of the skin are exceedingly dele- 
terious. The patients must be bathed frequently, 
therefore, and the bedclothes must be changed often 

1 An atmospheric thermometer should always be kept in 
the sick-room and in a large ward there should be two or 
three in as many different places. Never hang thermometers 
near windows, registers, or lights, and remember that the air 
is warmer near the ceiling and colder near the floor than in 
the intervening space. 



Ventilation 39 

enough to keep them odourless and clean. Bed-pans 
should be kept enveloped in a heavy cover, while they 
are being carried from the ward, and should be 
deodorised after a specially offensive stool. Bed- 
pans, urinals, and douche pans must be kept spotless. 
They should always be washed with hot water after 
use, and should be scalded, washed with hot soap- 
suds and sterilised or disinfected daily. A disin- 
fectant should be kept in the bottom of all sputum 
cups which cannot be burned, and they should be 
emptied, scalded, washed, and sterilised at least twice 
daily. Sinks, hoppers, and water-closets must be 
flushed, washed, and disinfected constantly. 

Trash 1 and garbage cans and the receptacles for 
soiled dressings 2 are often sources of contamination 
if they are not kept covered and if they are not 
cleansed and scalded daily. Garbage pails should 
be emptied at least three times a day. 

Defective plumbing is another frequent source of air 
contamination, and any stoppage or leak should be 
reported immediately. Stoppage is frequently due 
to carelessness (throwing orange peel and other in- 
soluble substances into the waste pipe for instance) , 
and sometimes to dropping bandages and instru- 
ments therein. When such accidents are reported 
immediately little damage is done as a rule, but if 
the object is allowed to remain in the pipe till it is 
washed down, it generally lodges where it is difficult 
to reach, and thus entails expensive repairs. 

1 Broken glass and crockery should never be thrown into 
the general trash can. 

2 Paper flour-bags make excellent receptacles for soiled 
dressings. They can be taken to the wards, the dressings 
put into them as soon as taken off the wounds, and the bags 



CHAPTER IV 

CARE OF THE WARD 

General Care of the Ward and its Furnishings. How to 
Remove Stains from Wood. How to Clean Brass, Copper, 
Nickel, Porcelain, Marble. Care and Disinfection of Mattresses, 
Pillows, and Bed-linen. How to Remove Stains from Linen. 
Amount of Linen Required for Ward Use. 

General Care of the Ward 

THE precautions against contamination described 
in the two preceding chapters will prove more 
or less ineffectual unless the ward itself and all its fur- 
nishings are kept spotlessly clean. Consequently, the 
best means of securing this indispensable cleanliness 
is a subject worthy of the most serious consideration. 

The Walls, etc. 

The walls of a hospital ward should be brushed 
once a week. A long-handled soft brush covered with 
dampened cheese-cloth is generally used for this 
purpose. Always begin at the top and brush down- 
ward taking care that every part of the wall space 
is swept. High chandeliers, high window-ledges, and 
all projections and cornices should be brushed at 

and dressings burned. This obviates the necessity of hand- 
ling the dressings and consequently prevents the dissemina- 
tion of germs. 

40 



Care of the Ward 4 1 

the same time. Low chandeliers, should be dusted 
daily with a dry dust-cloth as moisture effects electric 
lights, and window-ledges, etc., with a damp duster. 

The Floor 

The treatment of the floors depends upon the 
nature of their material. The dust should be removed 
daily from tiled floors with a brush covered with 
damp cheese-cloth, and scrubbed with soap or soap 
powder and warm water. Sapolio should never be 
used. Tiled corridor floors are sometimes mopped 
instead of being swept or scrubbed. In mopping, care 
should be taken not to use too much water, to 
change the water frequently, to wash only a small 
portion of the tile before drying it, to overlap the 
preceding section in washing a fresh section, and to 
press hard enough on the mop to remove all dirt. 

Hard-wood floors, which are more common in the 
hospital wards proper, than tiled floors, are parafined 
to make them impervious to germs. The following 
preparation is frequently used: parafine, 12 oz., tur- 
pentine, 2 gals., soft soap, 8 oz. The parafine is 
first dissolved in the turpentine, the soap is added, 
and the whole is then allowed to stand twenty-four 
hours. The floor should be either mopped or 
scrubbed before this mixture is applied, and should 
be afterwards well polished with a weighted brush. 
This process should be repeated every two weeks. 

The parafine floor calls for damp dusting — ordinary- 
dry sweeping should not be permitted — twice during 
the twelve hours of each day. The dissemination 
of dust may be avoided by using for this purpose a 
soft floor brush which has first been wet and then 
covered with a damp, unbleached muslin duster. 



42 Practical Nursing 

In doing a large ward, the duster should be changed 
at least six times. The appearance of the floor will 
be much improved by polishing it vigorously every 
morning, after dusting, with a brush tightly covered 
with a flannel or canton flannel bag. The dusters 
and bag should be thoroughly washed after use. 
Water will spot such a floor unless its action is imme- 
diately neutralised. If any water is spilled, therefore, 
it should be wiped up at once, and the floor should be 
rubbed with a mixture of equal parts of turpentine 
and oil. 

The Furniture 

Iron 1 and glass, owing to their non-absorbency, and 
the comparative ease with which they can be cleansed, 
are the ideal materials for hospital furniture, which 
should be simple and useful, absolutely without 
ornamentation and projecting points. It should be 
dusted daily with a clean, damp duster, 2 special 
attention being paid to cracks, crevices, and bars, even 
when not in view, where dust and consequently 
germs will rest. Once a week, or every other week, 
according to the situation of the hospital, the furniture 
should be given a special cleaning. 

Either whiting or Bon Ami is excellent for cleaning 
all painted or enamelled metal, nickel, and glass. 3 
To clean with whiting, mix with cold water just 
enough of the powder to produce a rich cream, rub 
the cream sparingly over the surface to be cleaned, 
and wash it off thoroughly with warm water, using 

1 Preferably painted white. 

2 A damp duster does not scatter the germs. 

3 Bon Ami is whiting made into cakes. It is expensive but 
is in a convenient form for use, 



Care of the Ward 43 

a clean duster. Soap, ammonia, or other alkalies 
should not be used for cleaning paint or glass. Alka- 
line substances soften and discolour paint, and, in 
time, remove the polish of glass. 

It being necessary in the hospital ward to dust 
even varnished and oiled furniture with a damp (not 
wet) duster, measures must be taken to counteract the 
effect of the moisture upon the varnish. This can 
be done by wiping immediately with a dry duster 
and by the weekly application of a mixture of equal 
parts of oil and turpentine, or oil and alcohol. 1 This 
emulsion must be applied sparingly, however, and the 
furniture rubbed afterwards till all greasiness has 
disappeared. 

To Remove Stains from Wood. — To remove 
white stains from coloured wood, rub well with 
tincture of camphor, equal parts of oil and tur- 
pentine, or oil and alcohol. Stains made by heat 
can sometimes be removed by the application of 
hot milk, followed by a rubbing with tincture 
of camphor. If alcohol is spilled on varnished or 
painted wood, pour oil over it immediately, before 
wiping up the alcohol. Grease stains on unvarnished 
wood are best removed by the use of strong alkalies — 
such as potash or soda — dissolved in ice-cold water. 
Wash off the alkali, after the removal of the grease, 
with hot water. To remove ink stains from wood, 
cover the spots immediately with some absorbent 
substance — such as starch, flour, or shredded blotting- 
paper. After a few minutes, remove the application 
and apply another of the same sort. Continue to do 

1 This does not apply to polished furniture. Cologne, or 
alcohol in any form should not be brought in contact with 
polished furniture. 



44 Practical Nursing 

this until the absorbent no longer becomes stained. 
Then rub the spots with lemon-pulp and common 
salt until they disappear. Wash the wood afterward 
with cold or tepid water. 

Cleaning Brass, Copper, and Nickel. — The 
sterilisers, hot- water cans, faucets, etc., are generally 
made of copper or brass, and, owing to their constant 
use, require frequent cleaning. There are various 
pastes, excellent for this purpose, on the market, but 
they are expensive. Oxalic acid and alcohol, and 
oxalic acid and ammonia are both frequently used 
in their stead. These mixtures clean well, but, in 
time, cause the metal to deteriorate. The addition 
of kerosene oil, however, by neutralising the acid, 
greatly lessens its bad effect and, also, furthers the 
cleaning process. A very effective polish can be 
made by dissolving two ounces of oxalic acid and one 
box of silicon in four ounces of alcohol, and adding to 
this solution one pint of kerosene oil. To use this 
polish, wash the metal to be cleaned with hot pearline 
water, wipe it well, and rub a little of the polish 
energetically over its surface with a piece of soft 
flannel. When all marks have been removed, 
burnish by rubbing with a piece of clean flannel or 
canton flannel. To clean nickel, silicon or whiting 
is generally sufficient, but if the stains are very bad, 
a little alcohol should be added. 

Cleaning Porcelain. — Stains can often be re- 
moved from porcelain tubs, basins, hoppers, sinks, and 
closets, by scrubbing the spotted places with tincture 
of iodine, and then washing them with warm pearline 
water. Benzine is also excellent for removing stains 
on porcelain, and will not injure the enamel. For 
the daily cleaning of enamelled objects, however, 



Care of the Ward 45 

soap or a soap powder suffices. Never use oxalic 
acid, or strong alkalies. They are all effective 
cleansers, but remove the polish and, in time, roughen 
the surfaces of the enamel. All sinks should be 
flushed daily with hot soda water, to keep grease from 
collecting in the pipes. 

Care of Marble. — Acids destroy the polish of 
marble. Therefore, if any acid, even orange or lemon 
juice, be spilled on marble, its action must be imme- 
diately neutralised by the addition of an alkali, such 
as ammonia or soda water. It is very difficult to 
remove stains from marble, but fairly strong solutions 
of alkali may be tried with safety, and will often pro- 
duce the desired effect. Stains made by oil, or other 
greasy substance, should be washed with a hot so- 
lution of soda water and a paste made of fullers' 
earth, which should be left on for twenty-four hours. 
It is often necessary to repeat the application several 
times before it is effectual. 

To Remove Rust from Iron or Steel. — 
To remove rust from iron or steel, wash the metal 
with sweet oil and while it is still wet, cover it with 
powdered quicklime. Allow this coating to remain 
for a couple of days. Then rub it off. If the rust 
has not disappeared, repeat the process. 

Hospital Beds 

They average from twenty-four to twenty-six 
inches in height, six feet and six inches in length, 
and thirty-six inches in width. A three-quarters 
bed is often used in private rooms, but never a 
double bed. It would be impossible to provide a 
double bed with sheets sufficiently wide to be tucked 
in far enough under the mattress to prevent wrinkles. 



46 Practical Nursing 

Besides all moving and lifting would be rendered 
much more difficult for both patient and nurse. 

The bedsteads must be disinfected after the dis- 
charge or death of a patient. Formaline i% and 
carbolic 1-40 are the disinfectants most frequently 
used. 

Mattresses. — Strong blue and white ticking is 
the best covering for mattresses, as fancy colours 
are liable to run when the mattress is disinfected. 
Ostermoor horse-hair is the best filling. It is more 
expensive than other varieties of horse-hair, but it 
wears so much better that it is cheaper in the end. 

The mattress, like the bed, must be disinfected 
after the discharge or death of a patient. When the 
patient has had a contagious or infectious disease, or 
a septic wound, it must be either baked or exposed 
to formaldehyde fumes. Under other circumstances, 
it is disinfected by whisking it well with a whisk- 
broom wet in a 2% formaline solution or a 1-20 
carbolic solution. 

To disinfect a mattress in the ordinary manner, 
proceed as follows: 

Protect the floor with a rubber. Bring the disin- 
fectant to the bed in an agate basin, dip the whisk 
into it frequently, and whisk vigorously, paying 
particular attention to all seams and tuftings. The 
same solution made half strength by the addition 
of water, is used to disinfect the bedstead. As 
disinfecting solutions are very expensive, only the 
amount required should be prepared. 

Air and Water Mattresses. — When patients 
come to the hospital with bed-sores, or when, for any 
reason (such as extreme emaciation, or general 
anaemia) , there is more than usual danger of their 



Care of the Ward 47 

developing such sores, it is often well to use air or 
water mattresses, which are made of rubber covered 
with ticking or canvas. To fit a bed with an air 
mattress, cover the springs with a fracture board 1 and 
place the air mattress upon that, then blow the air 
matt ess to the required stiffness with an ordinary 
force pump. There must be sufficient air in it to 
keep the patient from the board beneath, but not 
enough to cause pressure or to give the sensation of 
rolling. 

Since the invention of the air mattress, the water 
mattress has not been as much used as formerly, be- 
cause it is much the harder of the two to manage. It 
can be filled only after it is in place on the bed. 
When possible, the filling is done by means of a 
hose attached to a faucet; when not, the water has 
to be brought to the bed in pitchers and poured in 
through a funnel. The water should be ioo°F. 

If the patient is restless or unconscious, there is 
considerable danger of his falling out of bed when 
either of these mattresses is used. The simplest 
way to prevent this accident is to put on "side 
boards." (See Chapter VI.) 

Great care must be taken of both these varieties 
of mattresses, as they are very expensive. Sticking 
pins into them is the most frequent cause of injury. 
They should be disinfected with formaldehyde or 
carbolic after use, and a small amount of air left in 
them. 

1 The fracture board (so called because it is used under 
the mattress in certain fractures to guard against any discon- 
nection of the points of fracture, by the sagging of the 
mattress) should be the size of the springs. There must be 
several perforations in it for the admission of air. 



48 Practical Nursing 

The Pillows. — Feather and horse-hair are the best 
fillings for pillows for hospital use. Every bed is 
provided with a feather and a hair pillow, the feather 
one being the upper, except where the patient is 
suffering from high fever or profuse perspiration. Jn 
the former case, only one is allowed, and the hair 
being cooler is usually preferred. When there is 
profuse perspiration, or other conditions exist likely 
to cause the wetting or soiling of the pillow, a rubber 
pillow-case should be put on under the muslin one. 

Sheets, Blankets, etc. — The sheets for hospital 
use should be of cotton, and for a bed of the dimen- 
sions given on page 45, they should be two and three- 
quarters yards in length, and two yards wide. 

When sheets are removed from the bed of a patient 
suffering from a contagious or infectious disease, they 
should be enveloped in a sheet and put at once into the 
receptacle provided for the purpose, never on chairs 
or tables. Every hospital has its own method of 
disinfecting such clothing. Among these methods 
are: 

Exposure to live steam, boiling, or soaking in a 
disinfectant, such as carbolic, 1-40, or formaline 
1%. (See Chapter II.) 

The blankets should be two parts of cotton to one 
of wool. A larger proportion of wool will not stand 
the frequent washings, while a smaller proportion will 
not give sufficient warmth nor wear well. Care 
should be taken to prevent the unnecessary soiling 
of blankets, as washing greatly deteriorates them. 
Never allow the ends of a blanket to drag on the floor, 
and see that while it is over the patient, the top is 
well protected by the sheet and spread. Use an old 
blanket when one is needed next the patient, and 



Care of the Ward 49 

when there is likelihood of its becoming soiled in any 
way. Blankets are best disinfected by being ex- 
posed to the action of formaldehyde fumes. Dry 
cleansing is recommended when not too expensive 
as the blankets remain the normal size. 

Spreads should always be made of some light-weight 
material, such as dimity. 

It is often imperative to protect the mattress with 
a rubber. The black rubber blankets used by the 
United States Army are excellent for this purpose. 
White double-faced rubber is very nice for home 
use, but the frequent disinfection required in the 
hospital discolours it so soon that its use there is not 
advisable. 

When it is impossible to obtain rubber, oil-cloth, 
such as kitchen-table covers are made of, may be 
used, and, in an emergency, several thicknesses of 
newspaper, brown paper, or Japanese paper, tacked 
together. 

Method of Removing Stains from Linen, etc. 

A very important item in the care of the ward linen 
is the keeping it free from marks and stains. All 
stains should be removed before the articles are sent 
to the laundry. If they are put into cold or tepid 
water while the staining agent is still wet, it can 
usually be washed out without much difficulty. 

Bichloride Stains. — To remove bichloride stain, 
soak the stained linen in chlorinated soda (Labar- 
raque's solution) — one-quarter % for twelve hours. 
Then soak and wash thoroughly in hot water, for 
unless the soda is entirely removed the material 
will be destroyed. 

Blood Stains. — If blood cannot be washed out 



50 Practical Nursing 

with soap and tepid water, cover the surface with 
wet starch, making repeated applications. 

Coffee, Tea, and Fruit Stains. — Coffee, tea, and 
fruit stains can be removed by soaking in boiling 
water. If this fails, spread the spot over, a bowl of 
boiling water and rub with a solution of oxalic acid. 
Rinse afterwards with, first, ammonia water, and 
then clear water. 

Ink Stains. — Stylographic and red ink stains can 
generally be removed by washing with soap and 
tepid water, especially if the washing is done while 
the ink is still wet. Stains made with other inks 
are best washed with milk, or lemon juice and salt. 
Oxalic acid can also be used, but it will remove the 
fabric, unless it is washed off very carefully, as well 
as the ink. To use oxalic: Rub the stain until it 
disappears, with a soft piece of muslin wet with a 
saturated solution of the acid. Then neutralise the 
action of the acid by rinsing the article thoroughly in 
weak ammonia water. Turpentine will also some- 
times remove ink stains, and it can be used on coloured 
materials where the acids cannot. To use turpentine, 
soak the stain therein, and then rub it gently. 

Iodine Stains. — To remove iodine stains, wash 
with alcohol and then rinse in tepid water. 

Iron Rust. — To remove iron rust, spread the 
stained part over a bowl of boiling water, apply to it 
common salt, wet it with lemon juice, and then place 
it in the direct rays of the sun. Repeat the process 
until the stain becomes light yellow. Then wash 
it in weak ammonia water and afterwards in clear 
water. 

Vaseline Stains. — To remove vaseline stains, 
sponge with ether. 



Care of the Ward 5 l 

Amount of Linen Required for a Ward of 
Twenty-five Beds. — The majority of hospitals have 
a stated amount of linen for each ward and in order 
to keep this standard accurate the linen is counted at 
certain times during the year and all deficiencies 
supplied. Worn-out linen should be discarded or 
replaced monthly. A common standard for a ward 
of twenty-five beds is: 



Blankets (white) 


75 


(grey) 


12 


Nightingales 


24 


Nightgowns 


100 


Pillow-cases 


150 


Sheets 


224 


Spreads 


40 


Towels (hand) 


200 


(dressing) 


160 for a surgical ward. 


i i a 


60 for a medical ward. 


(food) 


50 


(medicine) 


12 


(dish) 


6 



CHAPTER V 

BED-MAKING, ETC. 

How to Make a Closed Bed, an Ether Bed, a Fracture 
Bed, a Bed with a Patient in it. How to Change the 
Nightgown, the Under Sheet. How to Turn and Change 
a Mattress with the Patient in Bed. How to Move a 
Patient from One Bed to Another. Lifting and Carrying. 
How to Draw a Patient up in Bed. How to Sit a Patient 
up in Bed. How to Get a Patient up in a Chair. "Morning 
Rounds." 

NO matter how clean and tidy the ward may be, 
it will not look so unless the beds are well 
made, and patients cannot be made comfortable in a 
loose, sagging, uneven bed. This matter of making 
the beds is, therefore, one of the first things to 
which nurses should give their attention. 

To Make a Closed Bed 

When a patient sits up, remove the clothes from 
the bed, one article at a time, as soon as he has left 
it, taking care that their ends do not drag on the 
floor. Then turn the mattress over — from top to 
bottom, letting it rest on the ends to air. When the 
mattress is sufficiently aired, put it in position, cover 
it with a sheet, leaving eighteen inches of the sheet 
to tuck in at the head and being particular to have 
it perfectly straight, and tuck it in on one side, well 
under the mattress. Put on the rubber, which should 

52 



Bed-Making, Etc. 53 

extend from under the pillow to below the place 
where the patient's knees will rest, and cover it with 
the draw sheet, 1 tucking them both in under the 
mattress. Go to the other side of the bed, stretch 
each of these articles tightly and tuck them in sepa- 
rately, beginning in the centre and working first toward 
the foot, and then toward the head of the bed. Fold 
the top of the under sheet like an envelope, and tuck 
it under the mattress. Put on the top sheet in the 
same general manner as the bottom sheet, but with 
the hem wrong side up, in order that the right side may 
be uppermost when the sheet is turned down over the 
blankets. Allow the upper end of the sheet to come 
to the edge of the mattress, leaving sufficient to 
tuck in at the bottom, just as the under sheet was 
tucked in at the top. A closed bed may be made with 
one or two blankets, but it will always look better if 
two blankets are used. In the latter case, tuck the 
first blanket in on the sides only. At the bottom 
fold it back, under itself, about six inches along the 
edge of the mattress. This blanket, like the sheets, 
should be pulled tightly before being tucked in, the 
good appearance of a bed depending largely upon its 
tautness. Fold the sides of the second blanket under 
the body of the blanket, taking care that the edge 
of the fold is on a line with the edge of the mattress, 
and tuck it under the mattress at the bottom. Place 
the upper edge of the spread on a line with the edge 
of the mattress, tuck it in at the bottom, fold the 

1 The draw sheet is a sheet made longer and sometimes 
wider than the ordinary sheet, so that it will double and tuck 
far in on one side of the bed and allow of being frequently 
drawn through to the other side, thus making a fresh spot 
for the patient to lie upon. 



54 Practical Nursing 

corners like an envelope, and tuck in the fold, allowing 
the sides to hang. (See illustration.) Shake the 
pillows pushing the feathers to the centre, press them 
on a table with the forearms, until they are perfectly 
flat, and push their corners well into the corners of 
the pillow-cases. Then place them on the bed. 

To Make an Ether Bed 

Put on the lower sheets and the rubber as when 
making an ordinary bed. Tuck the upper sheet and 
blanket in at the bottom, but not at the sides and 
fold them down to the foot of the bed. Lay a small 
rubber, covered with an ether slip or towel, on the 
place generally occupied by the pillows and tuck it 
under the mattress at the sides. 1 The only pillow 
used is one which is stood up at the head of the bed, 
to prevent the patient knocking his head against the 
bars, and which is kept in place by pinning the pillow- 
case over the bar. Place one hot-water can in the 
centre of the bed and another near the foot. Put a 
clean nightgown over the cans and cover them and the 
centre of the bed with two folded blankets. Move 
the table and chair, which stand beside the bed, to 
the back of the bed, to be out of the way of the 
stretcher, upon which the patient is brought to the 
bed. On the table, place a towel, two kidney basins, 
several gauze "mouth wipes" and a mouth gag, 2 

1 The head of the patient is kept low to reduce the work 
of the heart, and, by facilitating the flow of blood to the 
head to diminish nausea, which anaemia of the brain is likely 
to increase. 

2 Gardener's wooden labels make excellent tongue depres- 
sors. They are not so liable to break the teeth as metal tongue 
depressors and mouth gags, and they can be destroyed after 
use. 



Bed-Making, Etc. 55 

or tongue depressor, to be inserted between the teeth 
of the patient should they become clenched. Remove 
the hot-water cans from the bed as soon as the patient 
returns to it. Wrap one blanket around the feet and 
legs of the patient, and stretch another across his 
chest, where it serves to provide both warmth and 
restraint. The hot-water cans are not replaced in 
the bed unless the patient is in poor condition. When 
heat is necessary, hot-water bags are generally pre- 
ferred to the cans, because, being smaller, they are 
more readily controlled and are less likely to come 
into direct contact with the patient. Allowing a 
patient to be burnt with a hot-water bag is an unpar- 
donable crime. The greatest watchfulness must 
always be practised when a hot-water bag is used, 
especially if the patient is old, in a poor condition, 
under the influence of an anaesthetic, or unconscious 
from any other cause, since these circumstances 
predispose him to burns. Wounds thus produced 
are difficult to heal, and have caused permanent 
injury. 

To Make a Fracture Bed 

The only difference between a fracture bed, and an 
ordinary bed is that a perforated board, the size of 
the wire mattress, is placed between it and the hair 
mattress. This is to prevent any motion at the point 
of fracture by the sinking of the mattress. 

To Make a Bed with a Patient in it 

1. Before starting to make a bed with a patient 
in it, be sure that everything necessary is at 
hand. 

2. Loosen the bed-clothes on all sides. As vou 



56 Practical Nursing 

draw out the clothes with one hand, raise the mat- 
tress with the other, to avoid jarring the patient and 
tearing the clothes. 

3. Take the pillows out and shake them. If the 
patient does not object to being without them, leave 
them to air till the bed is made. 

4. Take off the spread, and, if there are two blan- 
kets on the bed, remove the upper one. 

5. Change the top sheet, if necessary. When 
crushed but not soiled the top sheet may be used for 
a draw sheet. 

6. Fold the lower blanket and top sheet up over 
the patient, leaving it just wide enough to cover him 
when he is turned. This answers a three-fold purpose : 
it gives a neat appearance ; the clothes are not in your 
way while you work; and it replaces the discarded 
blanket. 

7. Change the nightgown if it is soiled; if not, 
brush all crumbs out of it. 

8. Change the under sheets, if necessary; if not, 
tighten the under sheet and rubber and pull the draw 
sheet partly through, that the patient may have a 
fresh, cool spot to lie on. 

9. Rub the patient's back with alcohol and powder. 

10. Sweep all crumbs from the bed, either with 
the hand, a small whisk-broom, or a folded towel. 
Always use, the hand, under the patient, since only 
with it will all crumbs be discovered. 

11. Tuck in the top sheets and blankets, being 
careful to keep them loose at the bottom, over the 
patient's feet. If the weight of the bed-clothes on 
the feet is uncomfortable put a bed-cradle over the 
feet. 

12. Put on the spread. Tuck it in at the foot, 



Bed-Making, Etc. 57 

as when making a closed bed, but fold it back under 
the blankets at the top, and turn the upper edge of 
the sheet over it. 

13. Replace and arrange the pillows so that the 
patient lies comfortably, every part of the body being 
supported. 

These details should be carried out in the order 
in which they are given, since crumbs may be 
introduced into the bed by changing the night- 
gown, pillows, and upper bed-clothes after the lower 
sheet. 

To Change the Nightgown 

Changing the nightgown is a comparatively easy 
performance in the hospital, as the nightgowns used 
there are short and open down the back. Remove 
one sleeve of the gown to be discarded, and put on 
the corresponding sleeve of the fresh one, by passing 
your hand through it, grasping the patient's hand, 
and drawing his arm through. Slip the fresh night- 
gown across the chest under the soiled gown (thus 
preventing exposure) and proceed with the second 
sleeve as with the first one. When the gown is a 
closed one, have the patient lie on his back with his 
knees flexed. If he is strong enough, have him 
slightly raise his thighs; if not, place one of your 
hands under the buttocks and raise him, while you 
draw the gown up with the other hand. Then slip 
one arm under his shoulder, and, supporting his 
head with that arm, draw the gown well up around 
his neck. Slip one of your hands through the upper 
armhole of one of the sleeves, grasp his arm above the 
elbow, and bend it, while, with the other hand, you 
draw the sleeve off. Then draw the gown over the 



58 Practical Nursing 

head, and off the other arm. If the front opening of 
the clean gown is a long one, both arms can be drawn 
through the sleeves, before it is put over the head. 
When not sufficiently long for this, draw one arm 
through, and put the gown on over the patient's head 
before drawing the other arm through. Always put 
your hand through the sleeve and grasp the patient's 
hand while drawing the arm through. 

To Change the Under Sheet 

If the patient is fairly strong, the under sheet may 
be changed in the following manner. Turn him on 
his side, or draw him to the edge of the bed. Roll 
the under sheet over as far as possible. Lay the 
fresh sheet, which has been either folded fan-shape, 
or rolled, next to this, and tuck its free end as 
far under the mattress as possible. Be sure that 
the sheet is perfectly straight, and, if it is rolled 
that the roll faces the bed. Tuck in the rubber. 
Treat the draw sheet in the same manner as the under 
sheet. Then, either turn or draw the patient on to 
the clean sheet. Take off the soiled sheets, stretch 
the fresh ones and the rubber tightly, till they are 
absolutely free from wrinkles, and tuck them in 
firmly under the mattress. 

When the patient is too ill to be either moved or 
turned, it is oftener easier to change the sheets by 
working from the top to the bottom of the bed. 
Loosen the soiled sheet on all sides, draw it down to 
the nape of the neck, roll the fresh one, place it on 
the bed, and tuck its top edge under the mattress 
in order to keep it in place. Then, draw down both 
sheets together, slipping one hand under the patient 
and raising him as required. 



Bed-Making, Etc. 59 

To Turn and Change the Mattress, with a Patient in 

Bed 

To turn and change the mattress while a patient 
is in the bed take off the spread and upper blanket. 
Fold the upper sheet and lower blanket back over 
the patient. Unfasten the lower sheets and roll 
them tightly (roll side downward), till the rolls touch 
the patient on each side. Take hold of the rolls and 
lift the patient from the bed, while an assistant 1 
pulls out the mattress from the foot of the bed, turns, 
and replaces it. Then, let the patient down and 
tuck in the clothes. 

When it is necessary to exchange the hair mattress 
for an air mattress, withdraw the former in the same 
manner as when turning it, and slip in a fracture 
board before putting the air mattress in place. 

To exchange the hair mattress for another hair 
mattress (when, for any reason the latter part of the 
process described above is not practicable) : Lift the 
patient, after the sheets have been rolled up to him, to 
one side of the mattress, draw the old mattress half 
way off the bed and pull the new mattress up to it. 
Then, lift the patient on to the new mattress, with- 
draw the old mattress, draw the new mattress into 
position, lift the patient into the centre of it and 
unroll the sheets and tuck them firmly under it. A 
mattress may also be turned, in much the same way, 
if pillows for the patient to lie on during the process 
are placed on the side of the bed. The last two 
methods disturb him somewhat more than the first 
method, but they can be practised with fewer 
assistants. 

1 If the patient is very heavy, two persons will be needed 
to lift him, and a third to pull out the mattress. 



60 Practical Nursing 

To Move a Patient from One Bed to Another 

To move a patient from one bed to another, place 
the beds close together, loosen the draw sheet and 
draw the patient over by pulling the sheet. When 
the beds are of an unequal height, or when they 
cannot be placed together the patient must first be 
rolled in the upper sheet and blanket and then lifted 
and carried. Unless he is very light, it may require 
two persons to do the lifting and carrying. In this 
case both should take their stand on the same side 
of the bed. One should put her hands under the 
patient's shoulders and buttocks and the other under 
his back and thighs. They should draw him to the 
edge of the bed (urging him to hold himself stiff if 
possible) , lift him gently, in unison, and carry him to 
the second bed. 

To Lift and Carry 

In all lifting, the back should be bent as little as 
possible, 1 and, when two or more are lifting, they 
should act in unison. When a patient is carried, it 
is important for his comfort that the carriers step 
in unison. To lift a patient while he is in a sitting 
position, place your arm over his shoulder, taking 
a firm hold under the opposite axilla, have him clasp 
his hands on your far shoulder, and place your free 
arm under his knees. This method, though not 
always the most convenient, throws the strain on the 
lifters' shoulders, which can stand it much better 
than the back. 

To Draw a Patient up in Bed 

When a patient has slipped too far down in the 
1 Make the knees do the bending. 



Bed-Making, Etc. 61 

bed, and needs to be drawn up, flex his knees so that 
his feet will rest firmly on the bed; grasp him under 
his far arm, flexing your arm so that his head will 
rest in your elbow joint; put your other arm under 
his thighs, bend your knees slightly to avoid bending 
the back, and move him gently upward. If he is so 
heavy that it requires two nurses to move him, they 
should stand on opposite sides of the bed. One 
should grasp him under the arm, as if she were to 
move him alone, and place her other arm under the 
small of his back; the other should also place one 
arm under the small of his back, beside her com- 
panion's arm, and the other arm under his thighs. 

To prevent a patient from slipping down in bed, 
a piece of board six inches wide and twenty-four 
inches long, with two holes in each end may be used. 
Through these holes, run pieces of rope, long enough 
to tie to the head of the bed when the board is at the 
patient's feet. Pad the board or, if necessary, place 
a pillow against it. A good substitute for the board 
is a pillow doubled over a bandage, placed at the 
patient's feet. This should be tied first to the side 
of the bed on a line with the pillow, and then to the 
head of the bed. 

To Sit a Patient up in Bed 

To sit a patient up in bed, a back rest is very helpful, 
since it saves the use of a large number of pillows. 
Without one, it requires at least six pillows to make 
a patient truly comfortable. ' If, however, pillows 
are employed, dispose them in such a manner that 
the head will not be thrown forward on the chest, 
and that the small of the back will be supported. 
If the patient is inclined to slip down in bed, either 



62 Practical Nursing 

put a small, soft pillow under him, or fix a board or 
pillow at his feet, as already described. 

To Get a Patient up in a Chair 

To get a patient up in a chair, proceed as follows: 
Place a chair at right angles with the bed, make it 
comfortable by placing one pillow in the seat and 
another at the back. 1 Put a blanket cornerwise 
over the pillow, lift the patient, in the manner already 
described, into the chair. Wrap the blanket about 
him 2 leaving it rather loose around the arms but 
tucking it in snugly around the feet and legs and pin 
with a large safety pin. Count the pulse as soon as he 
is up, and again shortly afterward. 

After an illness of any severity a patient should 
seldom remain up longer than twenty or thirty min- 
utes the first day, and even a shorter time if the pulse 
changes. 

Morning Rounds 

The general work of the ward must be so planned 
that the taking of temperatures, giving of medicines, 
of nourishment, and of treatment will be strictly 
punctual. Much time is lost by poor calculation. 
It is easy to ''make work fit in" if just what there is 
to be done and the duration of each duty are passed 
in review at the beginning of the day. 

In the majority of hospitals, the house doctors 
make their rounds about o a.m. Before that hour 
the patients must have had their breakfast, the beds 
must have been made, the patients' daily records 

1 Put the open end of the pillow-case downward. 

2 A wrapper and stockings are all that the patient usually 
wears the first time he sits up. 



Bed-Making, Etc. 63 

written up, the dust removed from floor, beds, and 
furniture, and the ward put in perfect order. All 
the nurses should then be ready to attend the doctors ; 
not only because their help may be needed, but be- 
cause "rounds" is one of the opportunities for re- 
ceiving clinical instruction. There should never 
be laughing or unnecessary talking at the bedside 
during "rounds." Each nurse should be ready to 
attend to her duty promptly. 

It is generally the senior's work to precede the 
doctors and prepare the patients needed for examina- 
tion. When the chest is to be examined, the night- 
gown is either removed, or loosened and turned, as 
the case may require, and the chest covered with 
an auscultating towel usually made of firm cambric. 
For a vaginal or rectal examination, see "gynaecologi- 
cal positions," Chapter XVIII. For examination of the 
feet and legs, loosen the upper bed-clothes at the foot 
of the bed, fold back everything except the sheet, 
as high as required, leave the sheet covering the legs, 
till the doctor is ready, then gather it in between 
them. As the doctor often wishes to make some 
measurements, or examine the throat, the head nurse 
or one of her assistants should carry, in addition to 
the Order 1 Book and auscultating towel, a measuring 
tape, a mirror, a hand towel, 2 and a tongue depressor. 
It is generally the duty of one of the younger nurses 
to put things in order after the doctor is through with 
the examinations, that the ward may resume a pre- 
sentable condition. 

1 All "statum orders" should be carried out as soon as 
''rounds" are over. 

2 The towel is to be held in front of the patient's mouth 
while the doctor is listening to the sounds in the chest. 



CHAPTER VI 

CARE AND COMFORT OF THE PATIENT 

Care of Patient on Admission. Care of Patient's Clothes. 
Methods of Making Patient Comfortable. How to Give and 
Remove the Bed-pan. Care of Patient's Mouth. Prevention 
and Care of Bed Sores. Restraining Patients. Preparing 
Patient for the Night. Care of Patient at Night. Care 
after Death. 

ENTERING the hospital for the first time as a 
patient is in many cases a trying ordeal. A 
warm reception goes far towards reassuring those 
who entertain the misapprehensions so prevalent con- 
cerning hospitals, and dispelling groundless preju- 
dices and fears. It should never be forgotten that 
the care of a patient begins the moment he enters the 
ward, and great, indeed, must be the stress of work 
which will excuse a failure to give him immediate 
attention. 

Care of a Patient on Admission 

Many hospitals are provided with a reception ward, 
where patients are undressed and bathed, except 
when they are in a very bad condition, before they 
are sent to the regular wards. In other hospitals 
they are taken to the regular wards immediately. If 
a newly arrived patient is very ill, he should be laid 

64 



Care and Comfort of the Patient 65 

at once upon an opened bed which has been pro- 
tected with an extra rubber and a bath blanket. If 
he walks to the ward, he must be given a chair, either 
in a room adjoining it, or just within its entrance. 
In the latter case, he should be placed far enough 
away from the door to escape draughts, and to be 
out of the way of those passing. The nurse in charge 
of the ward, or if she is busy, one of her assistants, 
should come forward and speak to him immediately. 

Even though an entering patient has been seen by 
the doctor before admission, he may have become 
suddenly worse. If the exterior of the body is cold, 
apply heat and extra blankets and notify the doctor 
at once. In the majority of cases, the temperature, 
pulse, and respiration of a patient are taken as soon 
as he is admitted to the ward, and again in a couple 
of hours after he has had time to rest and recover 
from the excitement incidental to his coming to the 
hospital. 

Unless the patient's condition counter-indicates, 
a bath is always given him on admission. If his 
temperature is above ioo°F., or below 98°F., his pulse 
weak or irregular, or if he gives any history of present 
bronchitis, pleurisy, influenza, or other lung disease, 
the bath must be given in bed. In the men's ward, 
the orderly usually undresses the patient ; but if he is 
very ill, a nurse should assist. While undressing a 
patient, note his general appearance: whether he is 
fat or thin; whether there is oedema or recent loss 
of flesh 1 ; whether he is poorly or well nourished ; 
and whether there is any rash or any evidence of 

1 This can be told by the loose, baggy, and wrinkled ap- 
pearance of the skin. 

5 



66 Practical Nursing 

scratching. 1 Note also any signs of discharge, 
wounds, ulcers, or even slight abrasions of the skin; 
any swellings, growths, loss of motion or loss of any 
of the special senses. Report all abnormalities 
present to the nurse in charge; also any previous 
history volunteered by him. 

Care of the Patient's Clothes 

Take everything out of the patient's pockets. Place 
all valuables and important papers — money, jewelry, 
receipts, pawn tickets, etc. — in a package, writing on 
the wrapper the contents, the name of the ward, the 
patient's name, the nurse's name, and the date. Give 
this package immediately to the nurse in charge for 
transfer to the office. 2 The receipt therefor, which 
is generally given by the person who receives it in 
the office, should be kept by the head nurse till the 
patient is ready to leave the hospital. 

Examine the patient's clothes carefully for pediculi, 
remembering that, if they are present, they will pro- 
bably be found under the seams and in the gathers. 
If any are found, or if the patient is suffering from 
an infectious disease, fold the clothes neatly and 
envelop in a protector, 3 which is wet with formal- 
dehyde 2%, or other disinfectant of equal strength. 
List the clothes and make a record in the Clothes' 

1 If there are such evidences examine all hairy portions of 
the body for pediculi. 

2 The only valuables which ward patients should be allowed 
to keep are wedding rings (if they desire to do so at their 
own risk) and a small amount of change. Otherwise, loss 
followed by unpleasant consequences is likely to occur. 

3 In many hospitals the patient's underclothes are tied up 
in squares of unbleached muslin. They are then kept together 
and free from dust. 



Care and Comfort of the Patient 67 

Book of the patient's name, your own name, and the 
date. Pin with a safety-pin a tag inscribed with 
the name of the ward, the patient's name, the nurse's 
name, and the date, to the bundle, and transfer it 
immediately to the Sterilising Room. 1 

When the clothes do not need disinfection, fold the 
underclothes, shoes, and stockings in a ■ protector. 
Include the hat if there be room for it, if not give it 
a separate cover. Dresses and coats should be hung, 
not folded, and must be properly tagged. Put them 
in the locker provided for the purpose, and enter 
the number of the locker in the Clothes' Book. If 
possible, send badly soiled clothes home by the 
patient's friends; if not, write the patient's name and 
the number of his ward on tapes, with indelible ink, 
sew the tapes firmly on the clothes, and send them 
to the laundry. 2 It is a great unkindness on the 
part of nurses to mishandle or be careless about 
patients' clothes, as, no matter how old they may 
appear, they are probably of value to the owner. 

Methods of Making Patients Comfortable 

Making her charges comfortable is quite as im- 
portant a part of a nurse's duty as giving them medi- 
cine or treatments of which they cannot reap the full 
benefit if they are disturbed by mental or bodily 
discomforts. 

Mental Condition. — The patient's mind should 
be kept free from worry or excitement, his wants 

1 Formaldehyde fumes are now almost universally used in 
the disinfection of clothing, steam or dry heat being used 
for the destruction of vermin. 

2 These arrangements, are, of course, not exactly the same 
in all hospitals. 



68 Practical Nursing 

anticipated, his mind diverted from himself, the small 
irritations of daily life as far as possible removed, and 
a quiet restful atmosphere of cheerfulness established. 
The nurse should find out the subjects that interest 
her patients and inform herself upon those subjects. 
The discussion of family histories, previous experi- 
ences, either in the hospital or in families where she 
has practised her profession should be avoided. 

In private homes the nurse should strive to make 
her services indispensable by assuming household 
responsibilities when they are the cause of worry and 
distress to the patient, or by the performance of 
some of the slight offices of kindness that help to 
lighten the burden when sickness is present. 

Tiresome or garrulous members of the family or 
friends must be excluded or tactfully entertained 
to relieve the patient from that necessity and the 
servants who often object to the presence of a nurse 
must be propitiated. 

The nurse must sink her own personality in that 
of the patient and family. One who "understands" 
and is adaptable, who is neither officious nor a mar- 
tinette, and still has the required force to control 
others will prove herself a joy and a comfort to all. 

The fullest confidence in the doctor and his pro- 
fessional ability should be encouraged, and no circum- 
stances will excuse invidious comparisons with other 
doctors or disloyalty to him. 

The nurse who knows herself and the psychic 
influences that control our relations with others will 
feel intuitively if she is in harmony with her patients. 
If she fails to gain their confidence and becomes the 
cause of increasing irritability, her presence inter- 
feres with recovery. When the proper relations 



Care and Comfort of the Patient. 69 

exist and the nurse is conscientious, she will feel at 
once anything that will be disturbing, and protect 
her patient. In other words, she becomes the buffer 
between her patient and all disturbing elements. 

Bodily Comfort. — Some of the many devices 
tending to increase bodily comfort are: rubbing the 
body, particularly the back, with alcohol; pulling the 
draw sheet partially through, that the patient may 
be on a cool spot; changing the pillows when they 
have become disarranged, when their position ceases 
to be comfortable, and placing them in such a manner 
that they will fit into the contours of the body and 
give support. Small pillows, or hot- water bags, 
partially filled with cool or warm water, fit into the 
hollow of the back better than large pillows. A 
folded hair pillow, tied firmly together, placed under 
the knees will relax strain on the abdominal muscles. 
A triangular hair pillow specially made for this pur- 
pose is used in some hospitals, its base rests on the 
bed, and the knees are firmly supported in the fixed 
position over the top. 

Patients who, owing to dyspnoea, are obliged to 
sit up in bed continually are often more comfortable 
if they have something on which to lean forward. 
To such, give a bed tray with a pillow on it. In a 
private house a board with a block of wood nailed 
to either end, or even raised on a bundle of magazines 
tied firmly together, will answer the purpose. In 
such cases it is generally necessary to take measures 
to prop the patient up well in bed and to prevent him 
from slipping down. 

In cases of rheumatism, neuritis, etc., pain is some- 
times lessened if the affected parts are fixed by means 
of splints or sand bags. When there is inflammation 



70 Practical Nursing 

in an extremity, relief will often be given by elevating 
the affected part. An extremity thus elevated, 
however, must be supported its entire length, and the 
elevation should be gradual. When the weight 
of the bed-clothes causes discomfort to any part of 
the body, a bed cradle should be used to support 
them. 1 When the patient is very thin, either rubber 
air -rings, rings made of cotton batting and bandage, 
or pads made of cotton batting and gauze will relieve 
pressure if they are placed under or bound over the 
bony protuberances. 

Much discomfort is experienced when waiting for 
a drink, for delayed dressings, for a hot -water bag, 
and especially for the bed-pan. 

To Give and Remove the Bed-Pan 

When giving a patient the bed-pan, first flex his 
knees, so that the feet will rest firmly on the bed, 
then pass one hand under the lower part of the back 
and raise him as you insert the pan with the other. 
Raise him in the same way before attempting to 
remove the pan. If the bed-pan is cold, it must be 
warmed before being used. After a defecation, 
remove the bed-pan and when possible replace with 
a clean one and cleanse the parts thoroughly. As 
soon as it is taken out it should be covered, either 
with rubber or with a cover of thick washable material. 

Care of the Patient's Mouth 

The mouths of fever patients on liquid diet should 
be washed after every feeding. Improper care of 

1 A cradle can be improvised by using half barrel-hoops tied 
at each side to a stick or by placing a long pasteboard box on 
a thin board or a bundle of magazines. 



Care and Comfort of the Patient. 7 1 

the mouth may result, not only in ulceration of it 
and of the tongue, but also in infection of the ears 
and glands. The increase of tympanites and the 
reinfection of typhoid patients have also been traced 
to this source. In fever, the lining of the mouth 
becomes dry and cracked and a considerable amount 
of milk and broth collects in these cracks, affording 
food for germs which multiply rapidly. This mixture 
of dried epithelium, food, and germs, is called sordes. 
To cleanse the mouth, wrap a piece of gauze or 
absorbent cotton around the index finger (or around 
a small piece of whalebone), wet this in the mouth 
wash, and clean every part of the mouth thoroughly. 
Be particularly careful of the tongue. Several pieces 
of the cotton or gauze will be required, as the same 
piece must never be dipped in the solution twice. 
There are various mouth washes in common use. 
The best one for a given case will depend upon the 
condition of the mouth. Listerine, half strength, 
and Dobell's solution are always good. When the 
mouth is in a very bad condition it is well to use 
peroxide, diluted to half strength with either water 
or salt solution, before the regular mouth wash. A 
mixture of equal parts of albolene and of boric acid 
2% with a small amount of lemon juice is often 
effective for a very dry mouth. Glycerine can be 
substituted for the albolene, when the mouth is not 
very dry, but should not be used when it is, as, owing 
to its property of extracting fluid from the tissues, 
it increases the dryness. 

Prevention and Care of Bed Sores 

A bed sore is gangrene, or death of the tissue. It is 
the result of defective nutrition of the part where it 



72 Practical Nursing 

occurs. The bony prominences — such as the back 
of the head, ears, shoulder blades, elbows, lower end 
of the spine, the buttocks, and the heels — are most 
likely to be affected. 1 The predisposing causes are: 
lowered vitality (as in old age), continued high fever, 
paralysis, extreme emaciation, and general oedema. 
The immediate causes are: moisture, wrinkles, 
crumbs, and a too long continuance in one position. 
Therefore, see to it that the patient's bed is always 
dry. When a patient has involuntary micturition or 
bowel movements, put a large oakum pad, with a 
foundation of several thicknesses of newspaper, 
under him. If he is restless, bind the pad in place 
with a three-cornered piece of old muslin or gauze, 
putting the muslin or gauze on like a child's diaper. 
Look for crumbs after every meal, and brush them 
out, as already directed. Keep the draw sheet tight, 
to avoid wrinkles. Bathe and rub the affected 
parts with alcohol and powder at least thrice in the 
twenty-four hours. When the patient can be turned, 
frequent change of position will do much to prevent 
the forming of bed sores; when not, the affected parts 
must be relieved from all pressure by the use of 
rings. If rubber rings are used, they should be in- 
flated only just enough to keep the parts off the bed; 

1 Pressure sores are frequently seen when the patient 
remains constantly in the sitting position, when splints or 
stiff bandages with insufficient padding are employed, or 
when bandages are too tightly applied. They are also very 
common when two surfaces of the body are allowed to rub 
together, for example, where the legs fall together from 
weakness, or in corpulent persons when folds of flesh come 
in contact under the chin, the breasts, or in the abdomen 
or groin. 



Care and Comfort of the Patient. 73 

because when too hard they are very uncomfortable, 
and can be themselves the cause of bed sores. They 
should either be put in a pillow-case or wound with 
bandages. Small rings to fit the back of the head, 
ears, elbows, heels, and ankles can be made by tying 
a piece of cotton batting into a ring the required size, 
and winding it with bandage. When there is immi- 
nent danger of the breaking of the skin, the patient 
should be put on an air bed, and the affected parts 
should be washed gently with warm water and soap 
at least four times during the twenty-four hours, and 
rubbed with alcohol and powder at least every three 
hours. A preparation of flexible collodion (equal 
parts of collodion and of castor-oil) , painted over the 
surface, will sometimes prevent the skin from breaking, 
by forming a protective covering. The doctor should 
be notified when there is any indication that the skin 
is to break. Once it does break the resulting sore is 
often very hard to heal ; and not only does it become 
a cause of unnecessary suffering but the constant 
discharge from it is a severe drain on the patient's 
system. In fact, this drain may prove fatal, if it 
is not checked in season. 

The treating of bed sores belongs properly to the 
doctor's province, but, for some reason, it seems to be 
relegated very often to the nurse. A bed sore de- 
mands the same antiseptic precautions, and the same 
cleansing as any other wound but an ointment may 
be applied to it instead of the regular gauze dressing. 
An ointment of equal parts of castor oil and alcohol, 
thickened with zinc-oxide powder is frequently used. 
Massage and electricity, owing to their stimulating 
effect upon the circulation, are sometimes applied to 
the surrounding tissue with good results, 



74 Practical Nursing 

Restraining Patients 

It is very often necessary, especially at night, that 
a patient be restrained, to prevent him from getting 
out of bed, or otherwise injuring himself. Nurses 
are cautioned to make restraint perfectly effectual. 
Careless tying, which is only a pretence, is much 
worse than no restraint at all, because the patient, 
left to himself, may make his escape or do himself 
injury. In cases of mild delirium, "side boards" 
on the bed are all that are needed. These boards 
should be one inch thick, fourteen inches high, and 
two inches longer than the bed. If the bars at the 
head and foot of the bed are horizontal, the ends of 
the boards are shaped so that they will fit between 
them. A hole should be made in each end of each 
board in order that the boards may be kept in place 
by being tied to the bed. 

When handcuffs and anklets are resorted to, watch 
the patient's wrists and ankles for signs of chafing 
and pressure sores, and bind pads of soft cotton or 
gauze under the cuffs and anklets, if such signs appear. 
Stopping the circulation by a too tight adjustment 
of the restraint is another danger always to be guarded 
against. When no regular handcuffs or anklets are 
to be had, use squares of gauze (never bandage) folded 
cornerwise and tied in a modified clove hitch. 

To tie the clove hitch, proceed as follows: Make 
two loops forming the figure eight with both ends 
on top and going in opposite directions; put the loops 
together and pass them over the hand or foot as the 
case may be, drawing them just tight enough to pre- 
vent the hand or foot being slipped through ; make a 
knot in the ends about twelve inches from the extrem- 
ity and tie them to the bedstead. Great care must 
be taken to follow these directions implicitly, for, 



Care and Comfort of the Patient. 75 

when the clove hitch is improperly made, either it 
will not hold, or, worse still, it will tighten and shut 
off the circulation. A variety of camisoles, or 
strait-jackets, for restraining the movements of 
the body are in use. 1 When no such appliance is at 
hand, or when severe measures are not necessary, the 
body of a patient may be restrained in the following 
manner: Fold a sheet cornerwise and lay it under 
his shoulders; bring the ends up under the axilla, 2 
over the shoulders, and under the sheet at the back; 
cress them under the pillow and tie them to the head 
of the bed. This restraint will only be effectual when 
the hands and feet are also tied. A folded sheet put 
lightly over the knees, the upper part of the legs, and 
the abdomen, 3 and secured to the side of the bed by 
twisting around the bars, will sometimes also be 
required. When the patient is only slightly restless, 
this last method is sometimes sufficient. 

Preparing the Patient for the Night 

To prepare a patient for the night wash his face, 
hands, arms, axillae and back with hot water and 
soap; rub his back with alcohol and dust it with 
powder. Freshen his bed by shaking and turning 
the pillow, drawing a portion of the draw sheet through, 
(in order to give him a cool, new portion to lie on) 
sweeping out the crumbs and straightening the top 
clothes. 

1 The Bradford frame (see Chapter XVII) is one of the best 
appliances for restraining children. 

2 Never put the restraining sheet across the chest of the 
patient suffering from lung or cardiac disease as it may re- 
strict the movements of respiration. 

3 Never put a tight sheet across the abdomen of a patient 
suffering from any abdominal complaint. 



76 Practical Nursing 

In the hospital before the day nurses go off duty 
they must see that the ward cupboards, lavatories, 
etc., are in perfect order, and that there is on hand a 
plentiful supply of all necessaries, such as dressings, 
medicines, solutions, milk, broth, etc. They should 
also remove all cut flowers from the ward, and see 
that no soiled clothes or garbage are left to create 
odours. 

Care of the Patient at Night 

Owing to stress of work, it is often necessary 
to waken ward patients early in the morning. They 
should, therefore, have every opportunity to get to 
sleep early. The lights should be turned down and 
quiet be insisted upon by 8 p.m. 

It must be remembered that anaemia of the brain 
is one of the prerequisites to sleep. Hot-water bags 
at the feet or on the abdomen; hot drinks, particularly 
hot milk; and gentle friction of the forehead, or of 
the back of the neck, are a few of the many means 
of bringing about this condition. In hot weather 
or when the patient is suffering from high fever, 
moving him to the side of the bed and fanning the 
bed-clothes cool both the patient and the bed. Narcot- 
ics and anodynes should not be given, except under 
special circumstances, until all the mechanical means 
of inducing sleep have been tried. The majority of 
such drugs are cardiac depressants and producers of 
constipation. Above all there is a risk of generating 
a craving for them, and creating a drug habit. 

A night nurse must be constantly watchful. Patients 
are always likely to be worse at night, and sudden 
changes take place then much more frequently than 
in the day time. 



Care and Comfort of the Patient. 77 

As the night advances, the air grows colder, and 
the patient's vitality becomes less. Give extra 
blankets toward morning, not only to those who com- 
plain of cold, but to all whose lowered condition makes 
extra warmth advisable. 

The morning work of the nurse is very much the 
same as her evening work, but it involves, in addition, 
the arranging of the patient's hair. Only a patient 
in extremes should be considered too ill to have the 
hair brushed. If it is done daily, and in a proper 
manner, it calls for no exertion whatever on the part 
of the patient. To arrange a woman's hair, part it 
in the middle, and brush and comb each strand 
separately, beginning at the ends and working up- 
ward, holding it firmly between tangles and the head. 
Wetting the hair with a little alcohol will greatly 
assist in getting out snarls. It should be braided in 
two parts, above the ears, tied at the ends, and looped 
at the side of the face. 

Patients who are able to brush their own teeth, but 
who have no tooth-brushes, should be provided with 
a substitute, viz. : toothpicks, the tops of which have 
been wound with absorbent cotton. The mouths of 
all the sick patients should be cared for, as already 
described. 

The night nurse should write a clear and concise, 
but detailed, report of all treatment, medication, and 
nourishment given during the night. She should 
also record significant symptoms and all changes in 
the patient's condition. 

Care after Death 

Death is caused by the failure of one of the three 
vital organs — the heart, the lungs, or the brain — to 



78 Practical Nursing 

perform its function; in other words, by asthenia, 
apnoea, or coma. 

It is the nurse's duty in case of a serious change 
in a patient's condition to get permission from the 
doctor to summon the friends, but she should 
never give more than the most casual information 
regarding a patient's condition, or the cause of a 
patient's death, without being authorised to do so 
by the doctor. 

As soon as a patient has stopped breathing, 
straighten the extremities, close the eyes, and place 
a support under the chin to hold the jaw in position. 
In the hospital, nothing more is done till the doctor 
has seen the patient and pronounced life extinct. 
After this formality has been gone through, wash 
the body with a disinfectant; comb the hair, 1 
apply a Barton bandage to hold the jaw in place; 
fasten a triangular binder, with a large oakum pad 
(twenty-five inches square) in the centre around the 
loins like a child's diaper; 2 put on the shroud; and 
tie the knees, ankles, and hands in position with a 
broad bandage. Cover the body with a sheet and 
keep it covered till it is taken from the ward. 

In the hospital it is necessary that a card bearing 
the patient's name and age, the name of the ward, 
the date and hour of death, should be attached to the 
wrist for purposes of identification. 

Notice of the death should be sent, immediately 
after its occurrence, to the hospital office. 

1 If the patient is a woman, braid the hair. 

2 In former years the orifices were all plugged to prevent 
the escape of the post-mortem discharges and gases. The 
body so often became bloated and disfigured that it is now 
rarely done-. 



CHAPTER VII 

SYMPTOMS 

Difference between Subjective and Objective Symptoms. 
Chill. Colour. Coma. Cough. Cry. Cyanosis. Dyspnoea. 
Excreta. Sputum. Fasces. Sweat or Perspiration. Urine. 
Expression. Eyes. Hearing. Pain. Paralysis. Position. 
Pulse. Rash. Condition 01 the Temperature. Singultus. 
Respiration. Restlessness. Tongue. Tremor or Subsultus. 
Tympanites or Flatulence. Vomiting. 

AS the physician is able to spend relatively little 
time with each one of his patients, it is of 
the utmost importance that the nurse should be keen 
in noting and prompt and accurate in recording and 
reporting the phenomena by which the disease of 
a patient is diagnosed and his condition is judged. 
These phenomena are known as symptoms. 

Symptoms are subjective and objective. Sub- 
jective symptoms are those which are complained of 
by a patient, and objective symptoms are those which 
are observed by an onlooker. Subjective symptoms 
are often, owing to the youth or condition of the 
patient, impossible to ascertain; and, w^hen they can 
be ascertained, they cannot always be relied on. 
Objective symptoms, on the other hand, are almost 
always highly significant to an intelligent nurse. 
The following are the most common objective 
symptoms : 

79 



80 Practical Nursing 

Chill 

Chill, or rigour, indicates an unequal distribution of 
heat between the interior and the exterior of the body. 
The blood-vessels of the skin are contracted, and 
the blood is driven to the interior. This condition 
may be caused by contact with something colder 
than the body; or it may be the result of nervous 
irritation, 1 due, either to some disorder of the 
nervous system, to the toxic poisoning of disease, 
or to cerebral pressure. Chills vary in intensity, 
from slight shivering sensations to movements suf- 
ficiently powerful to shake the bed. They may 
last from a few seconds to an hour or more. Their 
severity and duration should always be charted; 
also their effect upon the temperature, pulse, and 
respiration. After a chill, the temperature is usually 
taken and recorded every hour till it falls to the 
average degree registered before the attack. A chill 
frequently marks the onset of certain diseases, such 
as pneumonia and the exanthemata. 

Colour 

Change of colour w T ill often be one of the first 
indications of a change in a patient's condition. 
The colour is also of great diagnostic value in many 
diseases. Among the colour symptoms are: the yellow 
that denotes jaundice or lead poisoning; the sallow 
complexion of opium slaves; the sallow, waxy skin 
of carcinoma; the waxy, yellowish shade often 
accompanying Bright's disease; the extreme pallor 
of haemorrhage and shock; the white skin and white 

1 Chills due to nervousness are not, as a rule, followed by any 
marked rise of temperature. When due to other causes 
the rise may be very great, reaching 105-106 F. 



Symptoms 81 

mucous membranes of anaemia; the bluish tint of 
cyanosis; the flushed face of high fever; the hectic 
flush of phthisis; and the single red cheek often 
present in pneumonia, when only one lung is con- 
solidated. A grey colour is typical of silver nitrate 
poisoning. A bronze shade is typical of Addison's 
disease; it is also often present, to some extent, in 
diabetes and cirrhosis of the liver. 

Coma 

Coma, or stupor, is a state of mental depression 
due to a paralysis of the cerebrum, which produces 
complete unconsciousness, and is always a very grave 
symptom, as it shows almost complete prostration 
of the vital forces. In coma- vigil, the patient lies 
with open eyes, but is unconscious and often delirious. 

Convulsions 

Convulsions almost always indicate some cerebral 
or nervous irritation. There are two varieties "tonic" 
and "clonic." In the former, irritation either of 
the brain or nervous svstem is constant, and the 
muscles are continually contracted. In the latter, 
the irritation is inconstant and the muscles are al- 
ternately contracted and relaxed. In children, convul- 
sions are frequently caused by reflex nervous irritation 
due to worms, indigestion, etc. The diseases which, 
in the adult, begin with a chill are, in the infant, 
ushered in with convulsions. The points to be 
noted in connection with convulsions are: the fre- 
quency and duration of the paroxysms ; whether they 
are general or whether only certain parts of the body 
are involved; whether the eyes are affected, and in 
what way; whether there is any frothing at the mouth ; 



82 Practical Nursing 

whether the colour, pulse, or respiration changes; 
and whether the attacks are followed by a rise oi 
temperature. (See Chapter XXIII.) 

Cough 

A cough is generally a symptom of irritation in 
some part of the respiratory tract, but is caused, at 
times, by a reflex nervous irritation. Its character 
will often indicate the cause. There is the short, 
sharp cough of nervousness; the deep, forcible cough 
of bronchitis; the wheezing, distressed cough of 
asthma; the small, hacking, constant cough of 
phthisis; the shallow, painful cough of pneumonia; 
the peculiar, hoarse, crowing cough of croup; the 
convulsive cough followed by a whoop, of whooping- 
cough; the peculiar, ringing cough, often present in 
aneurism of the aorta; and the distressed, breathless 
cough which is so frequent an accompaniment of 
heart disease and which is due to the constant irri- 
tation caused by dyspnoea. 

The nurse should note not only the character of 
the cough but also whether it is worse by day or by 
night, and whether it is accompanied or not by pain 
and expectoration. 

Cry 

Even a cry, especially in a child, is sometimes 
diagnostic. The moaning, wailing cry of an infant 
while ill, is very different from its cry of temper. 
The cry of colic is continuous and loud, and the child, 
when emitting it, writhes and twists its body. There 
is a peculiar sharp, ringing cry typical of meningitis. 

Cyanosis 

Cyanosis indicates the imperfect oxygenation of 



Symptoms 83 

the blood. It is a grave symptom in pulmonary 
and cardiac diseases and should be reported to the 
physician. 

Delirium 

Delirium is a state of mental excitement due to 
poisonous irritation of the cerebrum. It is of more 
serious import in some cases than in others. Nervous 
and alcoholic subjects are very apt to be delirious, 
when suffering from an illness of any gravity. In 
severe cases of pneumonia and typhoid, delirium is 
always to be expected. In heart disease, sepsis, 
and peritonitis it is a very untoward symptom. 

Certain forms of delirium are typical of certain 
diseases. Thus, there are: the low muttering de- 
lirium of typhoid; the hallucinations of alcoholism; 
the noisy, restless, and often violent delirium of 
delirium tremens and toxic poisoning; and the 
various delusions of patients bordering on insanity. 

The possibility of delirium must always be borne 
in mind in caring for the sick, as it often comes on 
very suddenly, and the patient unless he is watched, 
may get out of bed or injure himself. 

Dyspnoea 

Difficult breathing, like cyanosis, indicates im- 
perfect oxygenation of the blood. It may be due 
to improper heart action (either too much or too 
little blood being sent to the lungs for purification), 
or to some impediment in the lung circulation. 

Excreta 

The various excreta of the body always afford 
important indications of a patient's condition. They 
should be carefully examined, therefore, and any 



84 Practical Nursing 

abnormalities found in them should be reported. 
The excreta are: sputum, faeces, sweat, and urine. 

Sputum. — The sputum should be carefully studied, 
especially in lung and bronchial diseases. There are 
typical stages of the sputum in pneumonia (see 
Chapter XXIII). Any increase of blood, or darken- 
ing of colour in the pneumonia sputum is an adverse 
symptom. If it becomes very dark, it is known as 
prune-juice sputum. Prune-juice sputum is a very 
bad sign, as it denotes increased disintegration of the 
lung tissue. A thick, viscid sputum, the thinning 
and lessening of which indicate the approach of 
convalescence, is characteristic of bronchitis. In 
abscess of the lung, there is a yellow purulent mucus 
and pus (muco-purulent) , or pure pus sputum. In 
gangrene of the lung, the sputum is dark, purulent, 
and offensive. In tuberculosis of the lung, the 
sputum is thick and yellow, and contains the tubercle 
bacilli. 

The character, odour, and approximate quantity 
of the sputum should be charted. 

F^ces. — See Chapter XIII. 

Sweat or Perspiration. — Sweat, or perspiration, 
when not caused by natural means, such as heat or 
vigorous exercise, is usually indicative of weakness. 
If it is accompanied by a high temperature and a cold 
exterior it is a very serious symptom, since it denotes 
that the weakness is excessive. In certain diseases, 
such as phthisis and rheumatism, its presence is 
diagnostic. In certain other diseases, where there 
has been a continued high temperature, perspiration 
is a favourable symptom because it shows that the 
circulation is improving, and that the skin is once 
more resuming its normal function. It is sometimes an 



Symptoms 85 

indication of nervousness. It is the natural result 
of some drugs (diaphoretics), and is a sign of an 
over-dose of others. 

The odour of perspiration, its duration, the hour 
of its appearance, its quantity (whether slight or 
excessive) , and its position (whether general or local) 
should be charted. 

Urine. — See Chapter XI. 

Expression 

A pinched, anxious expression is characteristic of 
many forms of heart disease in all their stages, but, 
in the majority of illnesses, it generally signifies a 
change for the worse. It is also a symptom of 
haemorrhage. A dull, apathetic expression usually 
indicates a serious illness; it is particularly marked 
in typhoid fever, and its disappearance is always 
hailed as a sign of improvement. An over-alert, 
excited expression indicates mental derangement. 
It is of special moment when a patient has an alco- 
holic history, since it is often the first sign of an 
attack of delirium tremens. 

Eyes 

The condition of the eyes is an index of much that 
is occurring in the interior of the body, especially 
in diseases that affect the brain. A fixed, staring 
gaze, a shifty, restless movement of the eye, and a 
wild, excited look all indicate mental disturbance. 
In examining the eyes, the condition of the pupils 
particularly should be noted. Contraction of the 
pupils is one of the first symptoms of an overdose of 
many drugs — such as morphine and several narcotics, 
while other drugs, such as belladonna, advertise 



86 Practical Nursing 

their use in excess by a dilatation of the pupil. 
Strabismus (a deviation of the visual lin? of an eye), 
dilatation, uneven dilatation, or unnatural, and even 
more frequently, contraction of the pupils denote 
pressure on the brain, either from traumatism or 
disease. In certain brain diseases, photophobia, 
or sensitiveness to light exists. In jaundice, the 
sclerotic coat is streaked with yellow. In high fever, 
the eyes are glassy and often bloodshot. In wasting 
diseases, they are sunken, while in exophthalmic 
goitre, they are very prominent. Lachrymation 
(a running from the eyes) is frequently a forerunner 
of measles. Puffiness under the eyes may indicate 
kidney complications or arsenical poisoning. 

For the symptoms of local disease of the eye, see 
Chapter XXIII. 

Hearing 

In some diseases, especially those of nervous origin, 
the hearing may be very acute. In others, either 
through injury to some portion of the ear, or to those 
nerve centres in the brain which govern the sense 
of hearing, deafness or partial deafness may be 
present. Any suspicion of deafness, discharge from, 
or pain in, the ear, should be immediately reported, 
since disease of the inner ear is likely to complicate 
many diseases, — particularly, the exanthemata, 
diphtheria, meningitis, typhoid fever, and pneumonia. 
Improper care of the mouth is one of the frequent 
causes of the infection. 1 Temporary deafness and 
ringing in the ears often follow even small doses of 

1 The Eustachian tube is the channel of the infection (see 
Anatomy). 



Symptoms 87 

quinine. They also occur in weakness and general 
debility. 

Pain 

Pain is, of course, a subjective symptom, but a 
nurse has often to judge of its presence by such 
objective signs as position, expression of the face, 
restlessness, and crying. Pain may be general or 
local, dull or sharp, shooting, throbbing, and lanci- 
nating; it may be continuous or it may come on in 
paroxysms. Its presence, character, and the meas- 
ures employed for its relief, if any, should be charted. 

Paralysis 

Paralysis denotes pressure, either on some section 
of the brain, or on some other portion of the nervous 
system. The locality of the pressure is determined 
from the seat of the paralysis, each part of the body 
being under the control of special nerves which have 
their origin in certain regions of the brain or spinal 
cord. 

Position 

As a patient involuntarily assumes the position 
that will give the least pain and discomfort, position 
is often a symptom of importance. Thus, in ab- 
dominal pain caused by inflammation, the patient 
will lie on his back with his knees flexed, to relax the 
abdominal muscles; and, then, even the weight of the 
bed-clothes may disturb him. On the other hand, 
pain caused by colic, and other disorders of a like 
nature, is relieved by pressure, and a person suffering 
from these disorders will probably lie on the abdomen. 
In diseases of the lungs when only one is involved, 



88 Practical Nursing 

the patient will usually lie on the affected side, in 
order to give the normal lung more freedom to per- 
form its function. In certain respiratory and heart 
diseases, a sitting posture is the only one in which 
he can find comfort. In aneurism he leans forward. 
In some forms of meningitis the head is generally 
retracted and the legs flexed. 

Pulse 

For pulse as a symptom, see Chapter VIII. 

Rash 

Always examine carefully any appearance of rash, 
for an eruption is often one of the first diagnostic 
symptoms of the exanthemata. It is also one of the 
first signs of over-dosing with certain drugs, and must 
be watched for when these drugs are given. Various 
forms of rash, or urticaria, are caused by diseases of 
the skin, syphilis, indigestion, nervousness, and many 
minor disorders. Characteristic forms of erythema 
are associated with certain diseases. Such are the 
rose spots and sudamia of typhoid fever, and the 
roseola of cholera, while another form of roseola is 
often seen in Bright's disease. In meningitis, there 
is frequently a profuse eruption, but it is not constant 
in character. Herpes is a very common associate 
of meningitis and pneumonia. 

Some forms of purpura of haemorrhage under the 
skin resemble erythema. They are called petechiae, 
or ecchymosis, according to the size and form of the 
spots. They are due to changes in the blood, to 
obstruction in the blood-vessels, and to traumatism. 
They occur principally in cerebro-spinal fever, the 
exanthemata, and yellow, typhus, and rheumatic 



Symptoms 89 

fevers. A rash-like irritation of the buttocks in 
young infants, when not due to lack of care, is often 
an indication of intestinal trouble, or of improper 
feeding. An excess of sugar in the food, for instance, 
will cause the stools to have an acid reaction which 
frequently produces this result. 

Any appearance of rash should be reported im- 
mediately. Note where a rash first appears and the 
manner in which it spreads, as this is often of diag- 
nostic value. When there are scratches on the skin 
as well as a rash, examine the pubes and axilla, and 
hunt for pediculi. (See Chapter VI.) 

Singultus or Hiccough 

Hiccough is a very serious symptom, when it is 
due to any of the following causes: 

1. Exhaustion, as in typhoid, shock, or advanced 
chronic diseases. 

2. Central nervous disease, such as brain tumour 
and meningitis, and such as is caused by toxaemia 
diabetes, uraemia, etc. 

3. Local irritation, due to gastric carcinoma, 
peritonitis, intestinal obstruction, etc. 

Respiration 

For respiration as a symptom, see Chapter VIII. 

Restlessness 

When a patient is convalescent or not very ill, 
restlessness is to be expected, but in severe illness, 
it is generally regarded as an unfavourable symptom ; 
and the intense, irrational form associated with de- 
lirium is not more so than the mere restless plucking 
at the bed-clothes known as "carphology," which 
is one of the primary symptoms of delirium tremens. 



90 Practical Nursing 

Temperature 

For temperature as a symptom, see Chapter VIII. 

The Tongue 

The membrane covering the tongue being con- 
tinuous with that which lines the whole alimentary 
tract, any change in the latter is advertised by some 
change in the former. There are also conditions of 
the tongue which are typical of certain diseases, 
when it is white and furred, intestinal disorder is 
indicated, and in some intestinal diseases, it is par- 
tially denuded of epithelium. It is apt to be red and 
swollen in diabetes; scarred, in epilepsy; punctated 
like a strawberry, in scarlet fever; ulcerated, in 
mercurial poisoning, stomatitis, or syphilis. Its 
condition varies also with the different stages of 
typhoid. (See Chapter XXIII.) The clearing of the 
tongue from the edges is always a sign of beginning 
convalescence. 

Tremor or Subsultus 

Tremor or subsultus is an involuntary trembling 
of the body. It is characteristic of alcoholism. 
Occurring in the course of a disease, it indicates 
excessive weakness. 

Tympanites 

Tympanites is distention caused by an accumu- 
lation of gas — e.g., flatulence — in the stomach or 
intestine. It is generally due either to the fermen- 
tation of their contents, or, as in pneumonia, to 
the fact that carbon dioxide is generated and is 
retained on account of defective heart or lung action. 
In severe illness, flatulence is not only a serious 



Symptoms 91 

symptom, but., also, a serious condition, since, by 
increasing the work of the already wearied heart and 
lungs, it may cause death. In peritonitis, it is a very 
grave symptom, signifying the loss, or the partial 
loss, of the peristaltic action of the intestine. 

Vomiting 

The character of vomiting is of infinite importance. 
The frequency of vomiting, and the average amount 
and character of the vomitus should always be 
charted. "Character" includes the consistency, 
odour, and colour of the liquid; also, at times, the 
manner in which it is ejected. Projectile vomiting 
is always a very grave symptom. 'It occurs most 
frequently in brain disease, and in advanced cases 
of peritonitis. Green vomitus indicates the presence 
of bile. It is seen after the taking of anaesthetics 
and when there is any disorder of the liver. It is not 
of importance, unless long continued, except in 
diseases of the liver, when it points to some obstruc- 
tion of the bile-duct. Dark, acid, brownish-green 
vomitus is a very grave symptom, pointing to peri- 
tonitis. Dark vomitus having an appearance of 
coffee-grounds is another very grave symptom, and 
it generally means that haemorrhage has taken place 
in some part of the alimentary tract and the blood 
is digested. When vomiting occurs immediatelv 
after a haemorrhage in any part of the alimentary 
tract (haematemesis) , the blood, not being digested, 
will have much its ordinary appearance. If vomited 
blood is frothy, it has come from the lungs (haemop- 
tysis). A faecal odour to vomitus is of serious import, 
being generally the result of intestinal obstruction. 



9 2 Practical Nursing 

Mucus in the vomitus indicates gastritis, and mucus 
streaked with blood, gastric ulcer. 

Vomiting is frequently caused by reflex nervous 
irritation, when there is no local disease or irritation 
of the stomach. Thus, the vomiting of pregnancy, 
cerebral disease, appendicitis, etc., are not always 
caused by disorder of the stomach. 

Vomiting after fracture of the skull is a favourable 
symptom, as it shows that the pressure is not suffi- 
ciently severe to paralyse the reflex action of the 
nerves. It is also a favourable symptom in shock. 
(See Chapter XVI.) 

The Voice 

Hoarseness denotes congestion of the vocal cords. 
Aphonia (loss of voice) may be due to hysteria, to 
inflammation of the vocal cords, or to paralysis from 
pressure on the nerves of the vocal cords by tumour, 
etc. Aphasia (loss of speech) may be due to paralysis 
of the cords, or, to a cortical lesion. There are 
several varieties. Aphasia amnesic is a want of mem- 
ory for words. Aphasia ataxic is an inability to 
articulate words correctly. 

Charting 

In the majority of hospitals, a separate record, or 
chart, is kept for each patient. On this should be 
recorded his temperature, pulse, and respiration, 
and all the treatment and medication given him, 
with the result of the same. Thus: If a patient is 
given a narcotic, state whether or not, he slept; if so, 
how long, and how soon after taking the medicine. 
When stimulation is given, mention the effect upon 



Symptoms 93 

the pulse; a few days after starting a tonic, and 
periodically afterward make some remark about the 
appetite, never failing to report any abnormality 
therein. When a patient is on a liquid diet, or when, 
as in various forms of kidney disease, the amount of 
liquid taken is a matter of importance, measure and 
chart it accurately. 

All symptoms, whether subjective or objective, 
should be recorded. The frequency, and, with a very 
sick patient, the character, of each bowel movement 
should never be omitted. The urine should be 
measured and the result and time of voiding recorded 
in the following cases: in all kidney and heart diseases; 
for the first twenty-four hours after a patient' s 
admission to the hospital; after an operation; when- 
ever there is any suspicion of the passing of an ab- 
normal amount; when it is necessary to catheterise; 
in fact, whenever there is an abnormality of any 
description. When urine is voided involuntarily, 
the average amount should be estimated. With 
practice, a fairly accurate estimate can be made. 1 

Catamenia, and any attendant abnormality, such 
as menorrhagia or dysmenorrhcea, should also be 
recorded. 

Charting should be done neatly and plainly. To 
avoid wasting paper and making the record too bulky, 
employ small characters. Everything of any im- 
portance must be mentioned, but as clearly and con- 
cisely as possible, without using a single, unnecessary 
word. 

'When in doubt, pour measured water over a sheet, and 
see how much it takes to cover the same space as that wet by 
the urine. The amount of blood lost in a haemorrhage can be 
estimated in the same way. 



CHAPTER VIII 

TEMPERATURE, PULSE, AND RESPIRATION 

Forces Controlling Bodily Temperature. The Normal 
Temperature and Causes of Variation. How to Take and 
Record the Temperature. Care of the Thermometer. The 
Pulse. The Rate and Character of the Normal Pulse. Vari- 
ation from the Normal. Object of Respiration. Means by 
which Object is Attained. The Ratio of Respiration to Pulse. 
Stertorous Breathing, Dyspnoea, CEdematous Breathing, 
Cheyne-Stokes Respiration; Hiccough. 

NO symptoms are more significant than those 
which- have to do with temperature, pulse, and 
respiration. The organs controlling the tempera- 
ture, pulse, and respiration are all so intimately 
connected, that whatever affects one generally affects 
the others, in a greater or less degree. 

In health the body has a constant temperature 
the result of the action of two opposite processes; 
namely, heat production and heat elimination. 

The heat is produced in the individual cells by the 
oxidation of food, both food and oxygen reaching 
them by means of the blood. Since the muscular 
cells form so large a part of the active cells of the body, 
as a matter of fact, most of the heat is the result of 
muscular activity. The heat so produced is dissemi- 
nated by the blood throughout the body, the whole 
having practically the same temperature. 

94 



Temperature, Pulse, Respiration 95 

The elimination of heat is accomplished in two 
ways; first, by radiation from the blood-vessels, 
which pass near the surface of the skin, and those of 
the mucous membranes exposed to the air; particu- 
larly the mucous membrane of the lungs; and second, 
by the actual loss of warm substances from the body. 

The balance between heat production and heat 
elimination is controlled by the nervous system. 
When anything interferes with this rate of production 
or elimination, or with the balance between them, the 
temperature of the body changes. In toxic diseases, 
the poison causes an excessive burning up of the 
tissue (as is shown by the rapid emaciation) and there 
is a rise of temperature. When the surface of the 
body is chilled, the superficial blood-vessels are con- 
tracted and radiation of heat through the skin is 
partly lost, sometimes causing a very great rise of 
temperature. Excessive vomiting, diarrhoea, haemor- 
rhage or shock will often cause a decided lowering 
of the temperature through the prostration of the 
nervous system. 

The normal temperature of the human adult body 
is 98. 6° F., but it is subject to diurnal physiological 
fluctuations of from a fraction of a degree to a degree 
and a half. In health it rises gradually from 7 or 8 
a.m. until the same time in the evening, when it 
gradually falls. Thus it reaches its maximum be- 
tween 5 and 8 p.m., and its minimum between 2 and 

6 A.M. 

In infants and children, the average temperature 
is generally somewhat higher than in adults, while 
in old people, it is somewhat lower. 

Certain conditions will also produce small deviations 
of temperature. The process of digestion, excessive 



96 Practical Nursing 

exercise, excitement, constipation, or indigestion may- 
cause the temperature to rise slightly, while profuse 
perspiration or diarrhoea will lower it. 

The degree of temperature compatible with recovery 
from disease depends considerably upon the disease. 
Patients have recovered from sunstroke after a tem- 
perature of ii2° F. and even 115 F. In pneumonia 
105 F. is a frequent temperature, but 104 F. is con- 
sidered alarming in diphtheria. 

That the body can stand a greater increase than 
decrease of temperature is shown by the following 
table: 



Hyperpyrexia 


10 6° and over 


High fever 


103 -106 


Moderate fever 


101 -103 


Subfebrile 


99.5°-ioi° 


Normal 


98° - 99-5° 


Subnormal 


97° " 96° 


Collapse 


96° -95° 


Algid collapse 


below 95 



The course of the temperature varies in different 
diseases, and is therefore of great diagnostic value. 
In typhoid fever, it rises gradually, remains high for a 
certain length of time, and then declines as gradually 
as it rose. In pneumonia, the rise is sudden, and the 
fall may be either gradual or immediate. When the 
fall is sudden, the fever is said to terminate by crisis, 
when gradual, by lysis. 

Fever is classified, according to the course it runs, 
as continuous, remittent, or intermittent. It is 
continuous, when it is constantly high with but 
slight fluctuations, as in pneumonia; remittent, when 



Temperature, Pulse, Respiration 97 

it remains above normal but with a considerable 
range between its highest and lowest points, as in ty- 
phoid; intermittent, when it alternately rises to 
febrile height and falls to or below normal, as in 
malaria. 

Owing to the diurnal variations, which take place 
in disease as well as in health, it is necessary that the 
temperature be taken at the same time each day, if 
an accurate conception of its course be desired. 

How to Take the Temperature of the Body. — 
The clinical thermometer is the instrument used for 
ascertaining the body-temperature. The temperature 
can be taken in the rectum and vagina, under the 
tongue, and in the axilla and groin, the large blood- 
vessels in all these places being near the surface. 
Before using the thermometer, shake the mercury 
down to 95 , but be careful not to shake it into the 
bulb or the thermometer will be rendered useless. 

When taking the temperature by mouth, be sure 
that the patient has not had anything cold or hot in 
his mouth recently. Place the end of the thermometer 
containing the mercury under the tongue, on either 
side, close to the arteries. See that the lips are kept 
tightly closed all the time the thermometer is in the 
mouth and do not leave it there longer than is neces- 
sary. The length of time required will depend on 
the thermometer used. Hick's best Kew Obser- 
vatory Certificate Thermometer registers in half a 
minute, but, as it is necessary for the mouth to be 
closed at least two minutes to insure its temperature 
being unchanged by the outer air, the thermometer 
should be left in that length of time. Cheaper grades 
of thermometers require from three to five minutes 
for registration. 



98 Practical Nursing 

Never take the temperature of a young child, of 
a delirious or unconscious patient, or of a patient 
troubled with dyspnoea by mouth, since there is danger 
that the bulb will be bitten off. True, mercury in 
its metallic form is inert and would probably be dis- 
charged through the intestines without any harm, but 
it is better not to allow the accident to happen. If 
it does occur, see that there is no glass left in the 
mouth and notify the physician. Sometimes, white 
of egg, the antidote for mercurial poisoning, is given. 
In these cases, it is safer to take the temperature by 
rectum. It is also advisable to take a rectal tem- 
perature, when the patient is very ill, as the rectum, 
being a closed cavity, gives a greater degree of 
accuracy. 

Before inserting the thermometer in the rectum, 
oil the bulb and see that the cavity is free from 
faeces. Allow from five to ten minutes for regis- 
tration. The temperature will be one degree higher 
than it would be if taken by mouth. Never take 
the temperature by rectum when the rectum is 
diseased, and never allow a sick patient to insert the 
thermometer himself. If an infant struggles while 
you are taking its temperature, turn it on its face, 
or hold it face downward on your knee. When in- 
serting the thermometer with the child so placed, 
point it downward, toward the umbilicus, for the 
axis of the rectum is changed by this position. 

The axillary temperature will be from three tenths 
to half a degree lower than the temperature taken 
by mouth. Wipe the axilla thoroughly before 
placing the thermometer vertically in the hollow. 
Keep it in place by holding the arm close to the side 
and flexing the elbow so that the hand rests on the 



Temperature, Pulse, Respiration 99 

opposite shoulder. From ten to fifteen minutes 
will be required for registration, according to the 
grade of thermometer used. 

Children, hysterical, delirious, or fractious patients, 
should never be left while their temperature is being 
taken. Hysterical patients often resort to many 
mechanical devices, such as moving the thermometer 
in the mouth, holding it on a hot-water bag, etc., 
to obtain high registration. 

The temperature must not only be accurately taken 
but accurately recorded. 

A patient should never have access to his chart, 
and all questions regarding his temperature and con- 
dition should be evaded as far as possible. 

Care of Thermometers. — Keep the thermometers, 
when not in use, in a glass containing a solution of 
bichloride of mercury i-iooo, with a pad of absorbent, 
or other soft, cotton in the bottom. Wipe a ther- 
mometer carefully before giving it to a patient, and 
if you use it for more than one patient, wash it 
in a disinfectant and wipe it thoroughly between 
uses. 

Even the best thermometers should be compared 
occasionally, with some standard, as the bulbs grad- 
ually contract and they then register incorrectly. 
Owing to the constant breakage in the hospital, it 
is necessary to use cheap thermometers there. There- 
fore, it is necessary to test them weekly. To do so, 
put them into a glass of water, ioo° F., with a reliable 
chemical or dairy thermometer. Allow them to re- 
main there five minutes. Then, discard those which 
show any considerable variation from the standard 
thermometer. Such can, as a rule, be returned to 
the makers for repairs. 



ioo Practical Nursing 

The Pulse 

The pulse is the distention of the arteries by a, wave 
of blood forced through them by the contractive 
or systolic action of the heart. The interval between 
the pulse-beats is the period occupied by the diastole 
or relaxation of the ventricles of the heart as they fill 
with blood. 

Wherever an artery approaches the surface, this 
pulsation can be readily be felt and counted. The 
arteries in which the pulse can most readily be felt 
are the temporal, carotid, radial, femoral, anterior 
tibial and dorsalis pedis. For the sake of convenience, 
the pulse is generally taken at the radial artery, just 
above the wrist, on the thumb side. To count it, place 
the index and middle fingers over the artery, making a 
slight pressure. Count for a full minute, dividing 
the minute into quarters, the object of the division 
being to show whether the frequency of the pulse is 
regular or irregular. 

When taking the pulse of a patient for the first 
time, always take it in both wrists to ascertain if it 
can be felt equally well in both. Sometimes, owing 
to an unusual distribution of the arteries, an aneurism, 
or traumatism, there is an appreciable difference 
between these two pulses. 

The principal points to be considered in connection 
with the pulse are its frequency, force, volume, 
rhythm, compressibility, and tension. The normal 
pulse is even and regular in force and frequency, 
slightly compressible and devoid of hardness. 

Frequency. — By frequency, is meant the num- 
ber of pulsations in a given time. This varies — 
even in health — according to persons and conditions. 



Temperature, Pulse, Respiration 101 

The average pulse is: 

In men 60- 70 

" women 65- 80 

" children, above seven 



beats per minute. 



years 72- 90 

" " from one to 

seven 80-120 

" infants 1 10-130 

At birth 130-160 

Food, exercise, excitement, and sudden emotion, 
will all cause an increase in the frequency of the 
heart-beat. Position will also cause slight alterations, 
the pulse being quicker when a person is standing, 
than when he is sitting, and when he is sitting than 
when he is lying down. 

In describing the frequency of the pulse, use the 
following terms: ''frequent," for a pulse of 100-115; 
"rapid," from 115-140; "running," when over 140. 
Never speak of a quick or slow pulse in this connection, 
since these terms are only applicable to the rate of the 
individual beat. 

The ratio of the pulse to the temperature and 
respiration varies slightly in different diseases, but 
any great divergence is a grave symptom. When 
the pulse becomes accelerated in an undue ratio to 
the rise in temperature, haemorrhage or cardiac 
weakness is indicated. On the other hand, a dispro- 
portionately slow pulse points to cerebral pressure. 

Force. — The force of the heart-beat should be 
described as feeble, sluggish, normal, or forcible; or 
if some beats are feeble and others forcible, it should 
be described as irregular. 

Volume. — When the volume of the pulse is greater 



102 Practical Nursing 

than usual it is said to be large or full ; when less than 
usual, it is said to be small. 

Rhythm. — The rhythm of the pulse may be regular, 
irregular, intermittent, or dicrotic. In an irregular 
pulse, the interval between the beats is unequal. 
In an intermittent pulse, a beat is now and then lost 
— a less serious indication than an irregular pulse. 
In a dicrotic pulse, there is a secondary weaker beat 
(caused by the closure of the aortic valve), which 
indicates a relaxed condition of the arteries, and often 
accompanies acute fevers, particularly typhoid. It is 
difficult for the young student to detect a dicrotic 
pulse, but when the pulse is apparently much accel- 
erated and every other beat is weaker than the pre- 
ceding one she may at least suspect that the pulse 
is dicrotic. The two beats, representing only one 
contraction of the heart, should be counted as 
one. 

Compressibility. — When a pulse can be easily 
stopped by pressure with the finger, it is said to be 
compressible. Conversely, when it is harder than 
usual to obliterate, it is said to be incompressible. 

Tension. — The tension of the pulse, when not nor- 
mal, is either high or low. In a high-tension pulse — 
which is due either to contraction of the smaller 
arteries or increase in the force of the heart-beats, the 
artery remains persistently full, between beats, and 
is resistant to the finger-pressure. In a low tension 
due either to a weakened condition of the heart or 
relaxation of the peripheral blood-vessels — the pulse, 
though full, is soft and easily compressible. 

The other abnormal pulses — hard, soft, jerking, 
bounding, thready, wiry, and flickering — are accu- 
rately and sufficiently described by their names. - 



Temperature, Pulse, Respiration 103 

The Respiration 

The primary object of respiration is the purification 
of the blood. This is accomplished by the inhalation 
of oxygen and the exhalation of carbonic acid gas 
and of the impure, effete matter resulting from the 
combustion continually going on in the body. Oxygen 
has a greater affinity for blood than for air, and, when 
inhaled, readily leaves the latter to unite with the 
blood in the lungs. Carbonic acid gas, on the other 
hand, has a greater affinity for air than for blood, and 
as readily leaves the blood to unite with the air. 
This interchange of gases, known as osmosis, is 
assisted by the exceeding thinness of the walls of the 
air-cells and lung capillaries. 

The power which controls the respiratory move- 
ments (known as "the respiratory centre") resides 
in the medulla oblongata. 

Every respiration consists of two parts: inspiration, 
in the course of which the chest expands, and pure air 
is drawn through the trachea and bronchi into the 
lungs; and expiration, in the course of which the 
chest contracts, and air, which has been deprived of 
its oxygen, is expelled. The lungs take in from twenty 
to thirty cubic inches of air at each inspiration ; 
but they are only partly filled and emptied by each 
respiration, hence, fifteen or sixteen respirations are 
necessary to completely renovate their contents. The 
air remaining in the lungs after expiration is called 
"stationary or residual air." The air introduced 
with each inspiration is called "fresh or tidal air." 
The extra amount of air drawn into the lungs by deep 
inspirations is known as "complemental air." 

The respiration and the circulation are so intimately 



104 Practical Nursing 

connected, that anything affecting the blood will 
immediately cause a corresponding change in the 
respiration. In ' fever the blood, owing to the in- 
creased combustion of the tissues, is laden with 
an excessive amount of impurities. Therefore, the 
respirations become accelerated in endeavouring to 
supply an amount of oxygen sufficient to purify 
the blood. The respirations are also quickened by 
abdominal or thoracic pain, and often in hysteria. 
On the other hand, the respirations are diminished 
by such causes as narcotic poisoning, cerebral trau- 
matism or disease. 

Oxygen, being essential to life and health, patients 
should always have a plentiful supply of fresh, pure 
air, and should never be allowed, especially if they 
are helpless or unconscious, to lie with their heads 
thrown forward on their chests, since this position in- 
terferes with the passage of air to and from the lungs. 

The respiration being to a certain extent under the 
patient's control, it should be counted without his 
knowledge. To do this, count it while holding your 
fingers on his wrist, as though still taking the pulse. 
Watch the rise and fall of the chest-wall, and count 
an inspiration and expiration as one breath. 

In men and children the respiration is deeper than 
in women. The normal rate of respiration is: 

1 6-1 8 per minute in adults, 
20-24 " " " children. 

24-30 " " " infants. 

Respirations above forty or below eight are ex- 
tremely dangerous. 

The normal ratio of the respiration to the pulse 
is one to four. 



Temperature, Pulse, Respiration 105 

Respirations are described as regular or irregular, 
quiet or noisy, easy or laboured, deep or shall w. 

Other abnormal respirations are: Cheyne Stokes 
respiration, dyspnoea, oedematous breathing, ster- 
torous breathing and hiccoughs. 

Cheyxe-Stokes Respiration. — Cheyne-Stokes res- 
piration is a common accompaniment of advanced 
brain, heart, and kidney-diseases. It has also been 
noticed in perfectly healthy children during profound 
sleep. It appears in two forms. In one, the respira- 
tions gradually increase in force and frequency up to a 
certain point and then as gradually decrease until 
they entirely cease — a short pause ensuing before 
they begin again. In the other, the respirations 
gradually increase in force and frequency, likewise, 
but cease suddenly instead of decreasing gradually. 
This phenomenon may continue for some time. The 
causes of Cheyne-Stokes respiration are as yet im- 
perfectly understood. 

Dyspnoea. — In dyspnoea the respirations are forced 
and laboured. This condition is caused by a greater 
amount of blood being sent to the lungs than they 
are able to purify. It may be due to an increase 
in the heart -beat, or to an obstruction in the air- 
passage shutting off the required amount of air. 
It may also be due to congestion in the pulmonary 
capillaries and to nervousness. When it is so bad 
that the patient is unable to breathe in a recumbent 
position, it is known as orthopnoea. Apnoea means 
a complete suspension of the respiration. 

(Edematous Breathing. — In oedematous breathing, 
dyspnoea and cyanosis are extreme, and loud moist 
rales which are caused by the infiltration of serous 
fluid into the air-cells of the lun^ may be heard. This 



106 Practical Nursing 

condition is very serious, and unless it is relieved 
immediately death must ensue. 

Stertorous Breathing — Stertorous breathing is 
more common and less serious. It is characterised 
by a deep, snoring sound in connection with each 
inspiration. In cerebral haemorrhage the breathing 
is stertorous and the cheeks are puffed out with 
each breath. 

Hiccough. — Hiccough, which is caused by a sudden 
spasmodic contraction of the diaphragm, accom- 
panied by a spasmodic closure of the glottis, is of 
little import in health, but it is an adverse symptom 
in all abdominal diseases, especially when it persists 
after abdominal operations. 



CHAPTER IX 

BATHS AND PACKS 

Uses of Baths. Cleansing Bath. Bed Bath. Washing the 
Hair. Infants' Cleansing Bath. Baths and Packs for Stim- 
ulation and in Nervous Exhaustion. The Drip Sheet. Cold 
Tub Baths. Baths in Hyperpyrexia. Tub Baths. Sponge 
Baths. Slush Baths. Hot Packs and Baths to Relax Spasms 
or Cause Perspiration. Modified Hot Baths. Hot Air and 
Vapour Baths. Sitz Baths. Foot Baths. Continuous Baths. 
Medicated Baths. 

IN relieving unfavourable and painful symptoms 
and in regulating the varied phenomena of 
temperature, pulse, and respiration, a leading role 
has latterly been assigned by physicians to the bath. 

The Principal Uses of Baths 

Baths are used principally (i) for cleansing, (2) for 
general stimulation, (3) to induce perspiration, 

(4) for the reduction of temperature and inflammation, 

(5) as nerve sedatives and nerve tonics, and (6) as 
counter-irritants. Medicated baths are also used 
in specific cases, either for their local effect on the 
skin or for their general action upon the systems. 1 

1 A bath with a temperature of between $3° and 65 F. is 
known as a cold bath. 

A bath with a temperature of between 65 and 75 F. is 
known as a cool bath. 

107 



108 Practical Nursing 

The Cleansing Bath. — The skin serves the body 
not only as a covering, but also as an excretory organ, 
being in this respect quite as important as either 
the lungs or the kidneys. The skin performs this 
function through the agency of the sweat glands. 
Hence, if these glands become clogged, its work is 
interfered with. Especially in illness must this be 
prevented, as the waste products of the body are 
then particularly injurious and their presence in the 
system increases the danger of bed sores, boils, small 
abscesses, and a general toxic condition. The sweat 
glands can be clogged quite as readily by the secre- 
tions they are endeavouring to exude, as by anything 
from without. It is a mistake, therefore, to suppose 
that, when a patient is in bed, and does not appear 
dirty, a bath is not needed. The majority of patients 
should have at least a sponge bath every day if 
possible. In the hospital ward, this would be impos- 
sible, but, even there, every patient must be bathed 
at least twice a week, on regular days appointed by 
the head nurse. 

The ideal time for the bed bath is in the morning, 
an hour before breakfast; but in the hospital ward, 
where each nurse has several patients, the baths 
must be given at odd times during the day, as the 
work of the ward permits. It is imperative, how- 
ever, that an hour intervene between eating and 

A bath with a temperature of between 75 and 85 F. is 
known as a temperate bath. 

A bath with a temperature of between 85 and 92 F. is 
known as a tepid bath. 

A bath with a temperature of between 92 ° and 98 F. is 
known as a warm bath. 

A bath with a temperature of between 98 and 112 F. is 
known as a hot bath. 



Baths and Packs 109 

bathing, unless the meal consists of liquids, milk toast, 
custard, or other very easily digested food, in which 
case, half an hour will be sufficient. The reason why 
this delay is necessary is that the blood always flows 
in greater abundance to the part that is doing the 
most work. During digestion it directs itself, in ac- 
cordance with this law, to the stomach and intestines. 
If a bath is given, or violent exercise taken, however, 
it is diverted toward the surface, the digestion of the 
meal is interfered with, and proper assimilation fails 
to take place. 

The Bed Bath. — To give a bed bath: See that the 
windows are closed, and that the room or ward is 
sufficiently warm and devoid of draughts. Bring 
to the bedside everything required, namely; a large 
bath blanket, or preferably, two small ones, at least 
two towels — face and bath — wrapped about a well- 
filled hot-water bag, two wash-cloths, a toilet basket 
containing soap, ammonia, alcohol, nail-brush, etc., 
a foot-tub half full of water, no° F., and a pitcher of 
hot-water to keep the bath at the required tempera- 
ture. Draw the patient to the side of the bed. 
Place a folded bath blanket over the chest ; tuck a 
corner of it under the mattress, on both sides, to keep 
it from slipping down; turn down the bed-clothes, 
unfolding the blanket at the same time ; slip the second 
blanket, or, if one large blanket is used, one half of it, 
under the patient ; and take off the nightgown. Then 
proceed with the bath, washing first the face and 
ears, and afterwards the neck, chest, arms, back, 
abdomen, legs, and feet successively. In washing exert 
a firm but gentle pressure. Dry each part immedi- 
ately. Wash and dry the ears, the spaces behind 
the ears and between the fingers and toes, the axillae 



no Practical Nursing 

and the pubic region particularly well. When wash- 
ing the feet put them in the tub. Rubbing the 
patient at the end of the bath with alcohol, which 
evaporates rapidly, will further the drying process, 
and, also, harden the epidermis, thus lessening the 
danger of bed sores. Never expose your pa- 
tient. The whole bath can be given under the 
blanket. 

The bath must not be considered finished till the 
finger and toe nails have been inspected, and, if 
necessary, cleansed and pared. If the patient is 
exhausted after the bath, put a hot-water bag at his 
feet and give him a drink of hot broth. 

Washing the Hair. — To wash the hair: Have 
ready a pitcher of soap solution, a good supply of 
both hot and cold water, a jar into which to empty 
the water, an extra-soft towel, and a rubber to pro- 
tect the pillow. Bring the patient well over to the 
side of the bed, pin one end of the rubber round his 
neck, and make with the rest of it a trough extending 
into a foot tub or basin, which should be placed a few 
inches lower than the head. Pour first the soap 
solution and afterward the water from a pitcher, 
rubbing the scalp and hair well at the same time. 
Dry the hair as well as possible with a hot towel and 
by fanning. Do not braid it until thoroughly 
dry. 

While washing the hair of a new patient, examine 
the head carefully for pediculi and nits. The latter 
look like dandruff, but they cling tenaciously to the 
side of the hair, while dandruff will brush off readily. 
When there are many pediculi present, they are 
easily discovered. If there are only a few, however, 
they may escape detection. Therefore, in most 



Baths and Packs in 

hospitals, it is a rule to rub tincture of delphine 1 into 
the scalp after washing. When there is any sign of 
either pediculi or nits, comb the hair with a fine 
tooth comb, use an extra supply of delphine, and 
bind the hair up in a towel. If there are many nits, 
wash the hair with hot vinegar after applying the 
delphine. Repeat this treatment daily as long as 
necessary. "When the hair is tangled, rub a little 
vaseline into the scalp and wet the hair slightly with 
alcohol while combing it. Always hold the hair 
between the tangle and the head. 

The hair will not need to be washed often if it is 
kept well brushed, and is rubbed once in a while with 
a wash-cloth dampened in alcohol, one eighth per 
cent, or dusted with talcum powder. 

It is a general rule in hospitals that all patients, 
if their condition warrants it, shall have a bath on 
admission. Patients often object to this, and nurses 
must exercise the greatest tact to carry their point 
without offending. When the body temperature 
of the patient is subnormal, when he is suffering 
from shock or loss of blood, or is otherwise in a bad 
condition, baths must not be given without a special 
order from the doctor. Before giving a patient a 
bed bath, on admission, put a rubber sheet under the 
blanket, as it is often necessary to use a large amount 
of soap and water. When he is very dirty, add some 
ammonia, or borax, to 1;he water. Wrapping the 
feet with compresses soaked in one fourth per cent, 
green soap, or in soft flax-seed poultices, and leaving 
them so wrapped for two or three hours, will soften 

1 See Materia Medica. Crude petroleum is very efficacious 
for the same purpose, but it stains everything it comes in 
contact with, and is disagreeable to the patient. 



ii2 Practical Nursing 

callouses and make it easier to get them clean. If 
there is any appearance of body lice, follow the 
cleansing bath by a 1-5000 bichloride bath (see 
Chapter VI on Admission of Patient). 

When the patient's pulse is fairly strong and 
regular, temperature normal, and general condition 
good, a full tub bath generally is allowed. For a 
tub bath, fill the tub half full of water ioo° F. and see 
that towels, wash-cloths, and soap are at hand. 
Even when patients are able to take their own baths 
they must not be allowed to lock the bath-room door 
nor be left long alone. 

Infant's Cleansing Bath. — Have the tempera- 
ture of the room in which a baby is to be bathed 
7 2-7 5 F. The proper temperature of the water may 
be determined by the following table: 

For an infant under three months 95-100 F. 

Three months and upward 90-1 oo° 

One year 85- 90 

Two years 75- 8o° 

As a rule, a baby is not put into a tub until it is 
two or three weeks old. To bathe a baby under this 
age, envelop it in an old soft blanket or piece of 
eider-down flannel and hold it in the lap, protecting 
the lap by wearing an apron of Turkish towelling 
or similar material. 

Before giving the first bath after birth, rub the 
skin gently with vaseline or olive oil to facilitate 
the removal of the sebaceous matter adhering to it, 

Pay particular attention to the eyelids, ears, but- 
tocks, and all surfaces where two folds of skin come 
together. In little girls, separate and cleanse the 
two outer lips of the vulva. In little boys, draw the 



Baths and Packs 113 

fore-skin back once or twice a week to see that there 
is no dried urine, etc., adhering to the penis. 

In giving a baby a full bath in a tub, have sufficient 
water to cover the chest, and support its head on your 
left arm and its back with your left hand. 

Do not allow a baby under three months old to 
remain in the bath more than two or three minutes. 

After the bath, roll the baby in a warmed towel, 
dry by rubbing the hand briskly over the towel and 
powder lightly, especially where two folds of skin 
come together, taking pains not to leave sufficient 
powder to cake, or the object of the powdering — to 
prevent chafing and irritation of the skin — will be 
defeated. 

Sedative Baths. — When given as nerve sedatives, 
baths should be about 96 F. 1 The patient usually 
remains in the tub an hour, the water being kept 
during that time, at the required temperature. 

Packs 

Packs are employed more frequently as nerve 
sedatives, perhaps, than baths. There are many 
methods of giving packs. One of the most common 
is the following: Cover the patient with a blanket, 
remove the upper bed-clothes, and pass a large rubber 
covered with a soft blanket, under him. "Wring out 
two doubled sheets in water, &5 F., slip one under 
the patient's back, so that it will extend from the 
neck to the feet and come well up under the arms, 
and put the other under the top blanket, over the 
chest, around the arms, and between and over the 
legs. Bring the en Is of the under blanket up over 

1 Warm baths are a sedative, cold baths (when not long 
continued), a stimulant, and hot baths, a depressant. 



ii4 Practical Nursing 

the patient, and tuck the upper one snugly around 
him, making it particularly secure around the neck. 
Place cold compresses to the head, and a hot-water 
bag at the feet. Leave the patient in the pack from 
twenty minutes to an hour. At the end of that time, 
if the pack has been given to induce sleep, and has had 
the desired effect, remove the sheets, disturbing him 
as little as possible, and wipe him dry with a heated 
towel. If the pack has not had the desired effect, or 
if it has been employed as a nerve tonic, remove the 
blankets; but, before unwinding the sheets, give him 
a cold affusion (either by pouring water slowly from 
a pitcher, or by squeezing it from a sponge con- 
tinually dipped in water 75 F.), rubbing him with one 
hand while pouring with the other. Continue this 
treatment five or ten minutes, then remove the sheets, 
cover him with a blanket, and rub him briskly with 
hot towels. 

Packs and Baths for General Stimulation in Nervous 

Exhaustion, etc. 

The pack, as described above, is often used for 
general stimulation in nervous exhaustion. 

The Drip Sheet. — The drip sheet is used for the 
same purpose, when the patient is well enough to 
get up. Before starting the drip-sheet treatment, 
see that the room is at least 70 F., and have twelve 
inches of water 105 F. in the bath tub. Make the 
patient stand in this, with a blanket or sheet around 
him, wring out a sheet in water 75°F., pass it under 
the blanket and wind it around him, removing the 
blanket at the same time. At intervals of three 
minutes, pour water, ten to fifteen degrees colder 
than that in which the sheet was dipped, over the 



Baths and Packs 115 

shoulders and down his spine, rubbing briskly in the 
interim. Continue this procedure for ten to twentv 
minutes. Then, withdraw the sheet quickly, and 
envelop the patient in a dry, hot sheet, giving friction 
over this till all moisture is absorbed. 

Cold Tub Baths. — Cold tub baths, 65 F., are also 
often given as nerve tonics and for general stimu- 
lation. They are seldom continued longer than from 
three to five minutes, and should be followed by a 
brisk rub with hot towels. 

Baths in Hyperpyrexia 

At one time, the reduction of temperature was the 
only result looked for in the giving of cold baths. 
Now, it is considered but one of the minor benefits, 
a far greater one being the stimulation of the vaso- 
motor system and of the general circulation, with a 
view to preventing local congestions of blood in the 
vital organs. Other effects of cold baths are the 
stimulation of the processes of oxidation and nu- 
trition, and the elimination from the body, by the 
skin, of toxic materials. Frequent bathing also 
prevents the chafing of the skin and the formation 
of bed-sores, which, formerly were a frequent com- 
plication of fever, especially typhoid. 

As the primary effect of cold upon the peripheral 
vessels is their contraction and the driving of the 
blood from the surface to the interior, a cold compress 
or ice cap on the head is necessary in all cold baths 
to prevent retrostasis with determination of blood 
to the head. 

A hot-water bottle is always placed at the feet 
during packs and bed baths, and immediately after 
tub baths. Keeping the feet warm prevents rigour 



n6 Practical Nursing 

or chill, which is always to be guarded against, 
it being an evidence of muscular contraction and 
of a too decided difference between the temperature 
of the central and peripheral portions of the body 
and the good effect of the bath may be counterbal- 
anced thereby. Friction is also given for the same 
reason and is a very important item in administering 
cold baths. Friction must be continuous and light; 
since the patient soon complains of soreness of the 
skin and muscles, if it is too heavy. To prevent this, 
as well as for its greater effect on the deeper blood- 
vessels, it is well to alternate the friction with a light 
kneading of the muscles. 

A stimulant, 1 given fifteen or twenty minutes before 
the bath, is another means often taken to prevent 
chill and to counteract any bad effects the shock, 
caused by the sudden immersion, may have on the 
system of the patient. After the bath, a hot drink 
is given him, and, as a rule, a thin blanket is put 
over him. The blanket should be left on until reac- 
tion has taken place and the danger of chilling is 
over. The time required for reaction depends on the 
individual. Old people, children, and adults in a 
run-down condition will not react readily. A high 
temperature furthers a speedy reaction. 

Baths for hyperpyrexia are generally given every 
three or four hours while the temperature is 102.5 F. 
or over. Their temperature varies from 95 to 65 F. 
Their duration also varies, ten to twenty minutes 
being the average. 

The patient's temperature, pulse, and respiration 
should always be taken an hour after a bath, to see 

1 Whiskey is the form of stimulation most frequently used. 



Baths and Packs 1 1 7 

what effect it has had upon him. The after-bath 
temperature, etc., is charted with red ink. 

Brandt Bath. — The tub bath, as a treatment for 
hyperpyrexia which was introduced into Germany 
by Brandt in 1861, and which first came into common 
use in this country in 1890, has reduced the mortality 
of typhoid fever from 25 to 7%. 

To give this bath, it is necessary to have a portable 
tub which can be wheeled to the bedside, and to 
stretch a stout binder of muslin, in the centre of which 
an air ring is fastened, across the head of the tub, to 
support the patient's head. The other requisites 
are: a rubber sheet to protect the bed, a muslin sheet 
in which to roll the patient while drying him, an 
ice-cap, or a basin of ice with compresses for the 
head, a bottle of alcohol, a watch, non-absorbent 
cotton for the patient's ears, to prevent water from 
getting into them, safety-pins, a binder to pin around 
the abdomen, a bath-thermometer, and ice to keep 
the water at the required temperature. 1 

Almost the only objection to these tub baths is 
that, unless the lifting is most carefully done, there 
will be considerable strain on the abdominal muscles 
of the patient, thereby increasing the danger of 
haemorrhage and perforation. The best way to lift 
is to use a stretcher. This stretcher should be made 
of strips of webbing, one inch in width, and so lat- 
ticed together as to leave open spaces two inches 
square, and should have a doubled strip of canvas 
stitched on every side through which poles may be 
run. The stretcher is first passed under the patient, 
and the poles are then slipped in, the bath tub being 
provided with hooks, one on each end, for the support 

1 The tub should be filled three-quarters full of water. 



1 1 S Practical Nursing 



of the poles. The stretcher has several advantages: 
the lifting can be done by two people; it entails no 
exertion whatever on the part of the patient; and it 
supports him while in the tub. 

When there is no stretcher, there should be three 
people to lift the patient in and out of the tub. One 
takes the head and shoulders, another, the feet, and 
the third, reaching across the tub, passes her hand 
under the buttocks. Instruct the patient to hold 
himself as stiff as possible, and draw him to the edge 
of the bed before attempting to lift him. Begin 
rubbing him the minute he is in the water, com- 
mencing with the spine and extremities. 

Exposure of the patient can be prevented by 
stretching a sheet across the bed and tub, holding it 
in place by tucking one end under the mattress and 
pinning the other end to a bandage tied around the 
bath tub. 

As it may be necessary to take the patient out of 
the bath at any time, prepare the bed immediately 
for his return to it. Once daily, the mattress is 
turned and the bed remade. If this has already 
been done, tighten the under bed-clothes, cover them 
with an extra rubber, and put a hot-water bag at the 
foot of the bed. 

It is not an untoward indication if the pulse of 
the patient becomes smaller at the beginning of the 
bath, as this is due to the contraction, by the cold, 
of the superficial blood-vessels; but if it does not 
improve after a minute or tw r o, if it becomes soft 
and intermittent, and the face becomes cyanosed 
he should be taken out of the bath. 

The bath is generally continued for from ten to 
fifteen minutes. Take the pulse frequently. If com- 



Baths and Packs 1 19 

presses are used on the head, instead of an ice-cap, 
change them everv two or three minutes. 

In lifting the patient out of the bath, hold the 
stretcher above the tub for a few seconds to drain off 
the water before placing the patient on the bed. Then, 
roll a warm sheet around him, dry him well, by rub- 
bing over the sheet, take out the stretcher poles, roll 
the stretcher, rubber, and binder from under him at 
the same time, place the hot- water bag at his feet, 
cover him with a thin blanket and sheet, 1 the former 
being next him, and rub with alcohol. As soon as 
possible, give him a hot drink. 

In cases where it is impossible or undesirable to 
give tub baths, cold sponge-baths, slush baths, 
alcohol baths, or cold packs are substituted. 

Cold Spoxge-Baths. — In general, the same pre- 
parations are made for giving a sponge bath as for giv- 
ing the tub bath; but cotton need not be put in the 
patient's ears, and the water should be brought to the 
bedside in a foot tub instead of in a portable tub. 
A large sponge should be used. A sponge of Turkish 
towelling, gauze or old counterpane, is preferable to a 
sea sponge. Such a sponge provides a certain amount 
of friction. Furthermore it can more easily be re- 
served for an individual patient and can be changed 
oftener. Be careful, however, not to let its ends 
drag over the patient. If a sea sponge is employed, 
it should be soaked daily in a disinfectant. 

Protect the bed, from its head to its foot, with two 
rubbers, putting a muslin sheet between them. Pin 
a binder around the loins. Leave the rest of the 
patient exposed during the bath, in order to obtain 

1 These are left on until reaction has taken place and chilly 
sensations cease. 



120 Practical Nursing 

a greater radiation of heat. Place a hot-water bag 
at his feet, and cold compresses on his head. When 
practicable, this bath should be given by two nurses, 
since continuous friction may then be secured. It 
is quite possible, however, for one nurse to give it, 
and give it well by rubbing with one hand and spong- 
ing with the other. While sponging, keep the sponge 
full of water and take long, downward, sweeping 
strokes, squeezing the water from the sponge at the 
same time. Mop this water up constantly with the 
sponge and squeeze it back into the tub. Counteract 
the rise in the temperature of the water in the tub, 
occasioned by the introduction of the water from the 
sponge, by constantly adding ice to the former. 

During the first half of the bath time, bathe and 
rub the patient anteriorly. Then, turn him and 
bathe and rub the back. Before restoring him to 
his original position, mop up well the water on the 
top rubber, take out this rubber and the binder, roll 
the patient in a sheet, and give light friction until all 
moisture has been absorbed. The rest of the treat- 
ment is the same as in the bath tub. 

Slush Baths. — For a slush bath, protect the bed 
in the same way as for the sponge bath. The top 
rubber, however, should be long enough to extend 
into a pail placed on the floor at the foot of the bed. 
If it is not, make it the required length by the addition 
of a second rubber, sliding it up three or four inches 
under the first. Raise the rubbers on both sides by 
placing under them pillows which have been folded 
and tied, 1 thus forming a trough. Elevate the head 
of the bed to aid further in the drainage. 

1 In the absence of sufficient pillows, blankets which have 
been rolled and tied can be used instead. 



Baths and Packs 121 

There are two methods of giving slush baths. 
One method is to proceed as in the sponge bath, only 
using more water and not mopping it out so con- 
stantly. The other method is to place a tub, or large 
pail of water, on a stand, two or three feet higher than 
the bed, and to use a shower, or ordinary rubber 
tubing with a sprinkler attached, to convey the water. 
Move the sprinkler back and forth, holding it a couple 
of feet above the patient, that the water may fall 
with some force. Rub the patient and proceed in 
all respects as in the sponge bath. When no shower 
or sprinkler can be obtained, pour the water from 
a watering can or pitcher. 

Hot Baths and Packs 

The most frequent uses of hot baths and packs are 
to induce perspiration and relax spasms. Their em- 
ployment for the latter purpose is due to the fact that 
heat relaxes muscular tension. 

Baths to Relax Spasms. — Baths to relax .spasms 
must be very hot, 112 to 11 8° F. Apply cold to 
the head, as soon as the patient is put in the bath, or 
vertigo and fainting may result from the dilatation, 
and consequent congestion, by the heat, of the cere- 
bral blood-vessels. Watch the pulse very carefully, 
for the high degree of heat has a depressing effect 
upon the heart. Mustard is often added to these 
baths for its counter-irritant effect, though this, on 
account of the heat of the water, will be slight (see 
Mustard, Chapter X). If there are no bad results, 
the patient is kept in the bath from twenty to thirty 
minutes, unless the spasms cease sooner. On taking 
him out, roll him in a blanket. Keep the cold appli- 
cation on his head for some time. 



122 Practical Nursing 

Baths to Induce Perspiration. — Baths to induce 
perspiration need not be so hot. A temperature of 
105 to no° F. is sufficient. 

Hot Packs. — The hot pack is often used, especially 
for adults, in preference to the bath. To give the hot 
pack: Cover the patient with a blanket, folding down 
the upper bed-clothes to the foot of the bed. Slip 
two blankets with a rubber between them under 
him. These must extend from the head to the feet. 
Put an ice-cap or an ice compress on his head, chang- 
ing the latter every two minutes. Line a foot tub 
with a large rubber sheet — rubber side upward. 
Put in the tub hot- water bags l — four, if possible. 
Soak two small blankets — one of which is kept 
doubled — in water 150 F., leaving out two ends to 
hold while twisting. Wring the blankets quite dry, 
put them in the tub with the hot-water bags, and 
cover with the ends of the rubber sheet in order that 
they may be kept hot while being taken to the bedside. 
Slip the doubled blanket under the patient. Stretch 
the other blanket over his chest and around his arms 
and legs, without exposing him, 2 and tuck it snugly 
around him, especially at the neck. Place one of 
the hot-water bags at his feet, one under his knees, 
and one in each axilla, 3 and cover all with the rubber 
which has been lining the tub. Draw up the ends 
of the under blankets and rubber tightly around the 

1 Stone bottles make excellent substitutes for hot-water 
bottles. Even glass bottles can be used. To fill the glass 
bottles, stand them in warm water to avoid breaking. Stock- 
ings will make good hot water-bottle covers. 

2 Exposure is avoided by working under the blanket which 
covers the patient. 

3 Never put the hot- water bags next to the wet blanket. 



Baths and Packs 123 

patient, tuck them in, and pull up the bed-elothes. 
Take the pulse frequently, at the temporal artery. 
Encourage the patient to drink copiously — hot 
drinks, seltzer, or vichy. After twenty to thirty 
minutes remove the wet blankets and rubbers, and 
roll the dry blankets tightly around the patient. 
Let him remain thus for an hour, keeping the ice- 
cap on his head and the hot- water bag at his feet. At 
the end of the hour, give him an alcohol rub and 
remove the blanket. Rubbing the body with alcohol, 
under such circumstances, energises the nerve centres 
and transforms the passive activity of the skin into 
active vascular excitability. 

Hot packs are frequently ordered when the kidneys 
are not working properly. The profuse perspiration 
they induce eliminates through the skin a certain 
amount of the waste matter, which is poisoning the 
system, because it is not being secreted by the kidneys, 
as it should be. The heat also causes an increased 
oxidation of proteid waste and stimulates the kid- 
neys, as is evidenced by the increased amount of 
urine often voided after the pack. 

Modified Hot Packs. — Modified hot packs are 
sometimes given in connection with diaphoretic 
drugs . to further their action. To apply such a pack, 
remove the patient's nightgown, roll him in a hot, 
dry blanket, place hot-water bags at his feet and along 
his sides, and cover him with a rubber sheet tucking 
it firmly under the mattress. Leave him thus for 
half an hour, an hour, or longer, if necessary. 

Hot Air and Vapour Baths 

Hot air and vapour baths are frequent substitutes 



i24 Practical Nursing 



for the pack. To give a hot-air bath in bed, the 
following articles will be needed: 

An ice-cap. 

A hot- water bag and cover. 

Three blankets. 

Two large rubber blankets. 

Bed cradles, the number depending on their size. 

A bath-thermometer. 

A hot-air pipe and support. 

Asbestos to put around the top of the pipe. 

A Bunsen burner or alcohol lamp. 

Hot drinks. 

For a vapour bath, a croup kettle will be needed 
instead of the hot-air pipe, and a gas or large alcohol 
stove will be better than a Bunsen burner. 

In a private house, the elbow of a stovepipe five 
or six inches in diameter can be substituted for the 
hot-air pipe, and an old screen, clothes-horse, or 
wooden chairs, for the bed cradle. 

Method of Giving Bath. — Cover the patient with 
a blanket. Fold down and remove the top bed- 
clothes. Put a sufficient number of bed cradles 
over him to extend from his neck to his feet and cover 
these with a rubber. Draw out the blanket covering 
him and pass it up over the cradle under the rubber. 
Take off his nightgown, put the ice-cap on his head 
and the hot- water bag — covered — at his feet, wrap- 
ping the latter in a portion of the blanket on which 
he is lying. 1 Hang the atmospheric thermometer 
on the cradle at the top. Draw the ends of the 
rubber and blanket, which are under the patient, up 
over the cradle, under the rubber and blankets 

^he steam or hot air comes in almost directly over the 
feet. 



Baths and Packs 125 

covering it. Tuck in the latter under the patient 
on both sides and around the shoulders and neck. 
At the bottom, tuck them in under the mattress 
folding them around the air pipe. Put the top end of 
the air pipe in under the cradle three or four inches 
and cover this part of the pipe, and as much more 
of it as the clothes are likely to touch, with asbestos 
or old blanket dampened. Tie the pipe to the cradle 
at least four inches above the feet. See to it that 
the feet and lower part of the legs are securely covered 
and apart. Put the bed-clothes over the cradle. 
Tuck them in only at the foot and treat them there in 
the same manner as the blanket, taking care that the 
asbestos protects them from the hot pipe. Put the 
lamp or burner in the pipe and light it, so regulating 
it that the temperature inside the cradle will be 
raised from 1 50 to 1 75 F. Give the patient hot drinks 
or vichy while he is in the bath, and watch his pulse 
carefully. The bath is generally continued twenty 
minutes after the stated temperature is reached. The 
after-treatment is the same as for the pack. 

For a vapour bath, the croup kettle filled with 
water is used instead of the hot-air pipe. If its 
spout is not sufficiently long to go inside the cradle, 
attach to it a piece of tin or rubber tubing. 

Cabinet Baths. — When the patient is well enough 
to get out of bed, the cabinet bath is often used. 
To take this bath, he sits in a cabinet (with a thin 
blanket wrapped loosely around him) on an old chair 
under which an open saucepan of water is kept 
boiling on a gas or alcohol stove. 1 The cabinet is 
closed in such a fashion that the head is the only 

1 When an alcohol stove is used, it should be placed in a 
small pail. 



126 Practical Nursing 

part of his body exposed to the outer air. The 
treatment during and after this bath is the same as 
for the pack. 

Local Baths 

Local baths are most frequently used for the purpose 
of reducing inflammation. 

The Sitz Bath. — The sitz bath is given for the relief 
of inflammation or congestion of the pelvic organs or 
rectum. The heat, by dilating the superficial blood- 
vessels and relaxing the tension of the muscles, exer- 
cises a powerful analgesic effect upon the painful 
tissue. In the sitz bath, 1 only the thighs and the 
trunk to the waist line are immersed. To give this 
bath, fasten a large blanket around both the patient 
and the tub, and wrap a second blanket around the 
patient's feet and legs. The water should be about 
no° or ii2°F. The duration of the bath is generally 
from five to ten minutes. 

Foot Baths. — Foot baths are used for the re- 
duction of both local and remote inflammation (see 
Chapter X). To give a foot bath: Fold the bed- 
clothes up from the foot of the bed to above the 
patient's knees, replacing them with a double blanket. 2 
Turn part of the doubled blanket over the feet and 
back under the legs. Flex the knees and place the 
foot tub, half filled with water 115 F., lengthwise on 
the bed, between the folds of the blanket. Lift the 
feet with one hand and, with the other, draw the tub 
under them. Put them into the water slowly, that 

1 The sitz bath is best given in a tub specially shaped for 
the purpose. 

2 Be careful not to expose the patient while doing this, 



Baths and Packs 127 

they may become gradually accustomed to the high 
temperature. Fold the blanket around the tub and 
knees, and bring down the bed-clothes. In about 
ten minutes add hot water, being careful not to pour 
it in near the feet. The bath lasts about twenty 
minutes. Take out the feet in the same manner as 
you put them in, drying them well, and place a hot- 
water bag against them. 

Continuous Baths 

Continuous baths, both local and for the entire 
body, are often used in the treatment of badly sup- 
purating wounds, such as those resulting from burns, 
etc. 

Local Continuous Baths. — Tubs made especially 
for local continuous baths can be bought, but a foot 
tub can be made to answer the purpose. To give a 
local continuous bath: Tie a sling of muslin, for the 
support of the limb, loosely across the tub. Have 
sufficient of the prescribed solution in the tub to cover 
the inflamed area. Change this solution frequently 
and keep it at a uniform temperature. The specially 
made tubs are provided with taps for the purpose of 
drawing off the fluid. The foot tub will be emptied 
most easily by siphonage. To empty by siphonage, 
attach a funnel to a piece of rubber tubing, fill the 
funnel with water, put the tubing into the tub, and 
invert the funnel quickly. 

General Continuous Baths. — To give a continu- 
ous bath for the entire body ; Suspend the patient in 
a hammock made of soft webbing, and put a rubber 
air-pillow or ring under his head. Have the water 
come up to his neck and keep it at a uniform tern- 



128 Practical Nursing 

perature. Put some slats of wood across the tub 1 
and cover them with a blanket and sheet. When 
it becomes necessary for the patient to use the bed- 
pan, raise the hammock so that the body will be out 
of the water. Lift the patient out of the tub twice 
during the twenty-four hours and change the water. 
Scrub and disinfect the tub before refilling it. 

Medicated Baths 

Sulphur Baths. — To prepare a sulphur bath, 
dissolve sulphate of potassium (twenty grains for 
every gallon of water) in warm water, 95 F. Sul- 
phur baths must never be given in metal-lined tubs, 
as sulphur discolours metal. 

Bran Baths. — To prepare a bran bath, boil a 
pound of bran in a bag for twenty minutes, drain 
off the fluid and add it to the bath water, which 
should be about 95° F. The bath tub should be 
half full of water. 

Starch Baths. — To prepare a starch bath, dis- 
solve half a pound of starch in cold water, mix this 
with two quarts of hot water and add it to the bath 
water, the quantity and temperature of which are the 
same as for a bran bath. 

Bicarbonate of Soda Baths. — The bicarbonate 
of soda bath is used to allay itching of the skin. To 
prepare this bath, dissolve bicarbonate of soda in the 
bath water, allowing eight ounces of soda for every 
gallon of water. 

Sulphur, starch, bran, and bicarbonate of soda 
baths are all employed in certain skin diseases. The 
patient lies quietly in the bath for from five to twenty 

1 To keep the coverings of the tub out of the water. 



Baths and Packs 129 

minutes at the end of which he is enveloped in a hot 
sheet and dried gently, by patting — never by rubbing 
— with hot towels. 

Salt Baths. — Salt baths are given for their tonic 
effects. To prepare a salt bath, dissolve ten to 
fifteen pounds of sea salt in a tub half full of hot 
water, allowing it to cool to 65 or 70 F. In giving 
this bath, rub the patient well while he is in the tub 
and rub him again briskly with hot towels after he 
leaves the tub. 

Carlsbad axd Xauheim Baths. — Artificially pre- 
pared salts, for both the Carlsbad and Xauheim baths, 
which are supposed to have about the same chemical 
composition as the waters found at the kurs, can be 
bought in this country. These salts are dissolved 
in the bath water, which should be about 70 F. The 
patient lies quietly in the water the required length 
of time — about three to five minutes the first day, 
one or two minutes more the next day, and so on till 
the maximum time of twenty minutes is reached. 
After one of these baths, the patient should be en- 
veloped in a hot sheet over which friction should be 
given until all moisture is absorbed. He must not 
be allowed to exert himself in the least after the 
bath, and must rest quietly for a full hour, 



CHAPTER X 

COUNTER-IRRITANTS 

Inflammation. Use and Character of Counter-irritants. 
Hot-Water Bags. Mustard Foot-baths. Poultices. Fomen- 
tations. Iodine. Ammonia. Chloroform. Liniments. 
Guaiacol and Glycerin. Cupping. The Cautery. Vesicants. 
Cantharides. Local Applications Other than Counter-irritants. 
Ice Poultices. Ice-caps. Ice Coil. Ice Compresses. Anti- 
phlogistine. Starch Poultices. Ointments. Leeches. 

Inflammation 

INFLAMMATION is a complex morbid process 
caused by injury, chemical 1 or physical 2 irritation, 
or bacteria. The nature of it depends on its cause. Its 
cardinal symptoms are: redness, swelling, heat, pain, 
and local loss of function. It is characterised further 
by dilatation and congestion of the blood-vessels of the 
affected* part and by the exudation of the red blood 
cells, leucocytes, and blood plasma into the tissue. 

It is known, according to the character of the 
exudation, as fibrinous, serous, or purulent. The 
last-named variety is always associated with 
suppuration, and is the result of germ invasion. 

Repair takes place either by " resolution " or by 
"suppuration." In " resolution, " the exuded ma- 

1 Such as may be produced by corrosive poisons. 

2 Such as may be produced by excessive heat, cold, or 
electricity. 

130 



Counter-irritants 1 3 1 

terial is reabsorbed. In "suppuration," the white 
corpuscles and cellular tissue become disintegrated, 
resulting in the formation of pus — a composition of 
disintegrated cellular tissue, white corpuscles, and 
blood plasma. 

Counter-irritants 

When, from any cause, there is inflammation of 
any of the tissues or organs of the body, an increased 
amount of blood collects therein. 

Counter-irritants are often applied for the relief of 
this condition, it having been shown, by experiments 
on animals, that, when the vessels of the skin are 
dilated by the application of an irritant, those of 
the subjacent viscera are often reflexly contracted, 
thereby relieving any congestion and pain 1 that may 
exist in these viscera. 

Counter-irritation may be made either directly 
over the seat of the inflammation or at a distant part 
of the body. Thus, a hot foot-bath is given for the 
relief of pain in the head or abdomen, for colds in the 
head and for sore throat. Counter-irritation may 
also be made at a spot known to be connected inti- 
mately with the diseased area by nerve-fibres. Thus, 
in diseases of the eye the blister is sometimes applied 
at the back of the ear. 

There are three varieties of counter-irritants: the 
rubefacients or reddeners; the epispastics, vesicants, 
or blisterers; and the caustics or escharotics. 

Rubefacients. — Great care must be taken in 

»It is to be understood that this is a reflex nervous action, 
in no way due to the withdrawal of blood into the dilated 
vessels of the skin. 



13 2 Practical Nursing 

using rubefacients not to allow them to blister, as 
the resulting wounds are often very hard to heal. 
The rubefacients in general use are: heat, both dry 
and moist (obtained by the use of hot-water bags, 
poultices, and fomentations) ; mustard, turpentine, 
iodine, ammonia, 1 certain liniments, cupping, and 
the actual cautery. 

Moist heat is more penetrating than dry. It eases 
pain more quickly and more efficiently than dry 
heat but it also promotes suppuration by increasing 
the activity of the leucocytes or white blood cor- 
puscles and softening the tissues. Its continued 
use, therefore, is contra -indicated, unless the area 
of inflammation is deeply seated, as in pneumonia, 
or unless it is desirable to hasten suppuration. 

Hot- Water Bags. — Water bags, when used for 
counter-irritation, should be very light and very hot. 
Hence they should have very little water and no 
air in them. Their effect upon the skin must be 
very carefully watched. 

Mustard. — Mustard, as an external counter-irri- 
tant, is employed in baths, foot baths, pastes or 
sinapisms, and poultices. The chief constituent of 
mustard is a substance known as sinalbin, which, 
upon the addition of water, is changed into sulpho- 
cyanate of acrinyl, a volatile oil with a caustic, 
irritating action. Heat lessens the irritating property 
of the acrinyl. Therefore, when a strong counter- 
irritation, dependent solely upon the mustard, is 
desired (as in a sinapism), the water used in mixing 
must not exceed ioo°F. In a poultice, on the other 
hand, and, as a rule, in baths and foot baths, heat 

i Ammonia is also used as a vesicant. 



Counter-irritants 1 33 

is the primary object, and the mustard is added only 
for the purpose of increasing the irritation in a slight 
degree. 

Mustard Baths and Foot Baths. — To prepare a 
mustard bath or foot bath: Dissolve mustard in hot 
water in the proportion of two tablespoons full of 
the former to a gallon of the latter. Stir the mixture 
well just before giving the bath (see Chapter IX) . 

Mustard Sinapisms. — There are two varieties of 
mustard sinapisms, (i) the paste, and (2) the leaf. 

Mustard Leaf. — To prepare a mustard leaf for use 
dip the leaf in tepid water and fold over the face 
one thickness of gauze and over the back three or 
four thicknesses. When the patient is ready for the 
application of the sinapism carry it to him between 
the folds of a towel. Apply the side which has only 
one thickness of gauze to the skin, and lay the towel 
over it. The sinapism should remain on till the skin 
is well reddened, which it generally will be in fifteen 
or twenty minutes. After removing the sinapism, 
wash the skin with soap and warm water, as any 
adhering particles of mustard will continue their 
work, and blisters will result. If the skin is too much 
irritated, rub on a little vaseline or oil. 

Mustard Paste. — To make a mustard paste, mix 
one part mustard with three to six of flour for an 
adult (ten to twelve for a child), crushing all lumps, 
and add sufficient tepid water to make the mixture 
thin enough to be spread on gauze or cheese-cloth. 
When the patient's skin is tender, it is advisable 
to add either white of egg, oil, or vaseline, also since 
any one of these substances will lessen the irritating 
action of the mustard without detracting from its 
strength. The paste should be enveloped in gauze 



134 Practical Nursing 

and applied to the patient in the same manner as 
the leaf. 

Poultices. — Large poultices are best spread on 
muslin and covered with gauze or cheese-cloth. 
Small poultices can be spread on the thinner material, 
and should be covered in the same manner as the 
mustard paste. A poultice should always be covered 
with a protector of oiled muslin or old flannel in 
order to keep in the heat, and held firmly in place 
with a binder or bandage. A poultice for the chest 
should always be shaped to fit around the neck and 
armpits. 

To Make a Mustard Poultice. — A mustard poultice 
for an adult 1 should contain one part of mustard to 
six or eight of flaxseed, and about equal proportions 
of water and meal. Three cups of water and two and 
a half of meal will be required for a poultice of ordinary 
size for the chest or lumbar region. 

To Prepare the Poultice. — Mix the flaxseed and 
mustard together, crushing all lumps. Add them 
slowly to boiling water, as it boils, stirring the water 
all the time with a knife or spatula. When the mix- 
ture is just thick enough to drop from the spatula 
remove it from the flame, beat it well, to make it 
lighter by introducing air, and spread it thickly and 
evenly, a quarter of an inch thick, on muslin or gauze. 
When spreading it on muslin, leave a two-inch margin 
all around the poultice to turn back over it. Cover 
the poultice with a piece of gauze large enough to 
extend at least three inches beyond it on every side. 
Fold the margin under, between the muslin and the 



J For a child, the proportion should be one part of mustard 
to ten or twelve of flaxseed. 



Counter-irritants 135 

protector. Carry the poultice to the bedside rolled 
in a warmed towel. 1 

To Apply a Poultice. — Before applying the poultice, 
test its temperature by holding it to your face. Put 
it on slowly, for the patient will be able to stand it 
hotter, if it is let down a small piece at a time. Cover 
with a binder, or bandage. When the poultice is 
for the chest or lumbar region, slip the binder under 
the back, roll up the nightgown above the seat of 
application, and cover the latter with a hot towel in 
which the poultice was rolled. Then slip the poultice 
under the towel, thus avoiding exposure. Remove 
the towel before fastening the binder. 

A poultice should not be left on longer than one 
hour, as after that it is not even as warm as the body. 
After removing it, dry the surface of the skin and, if 
the skin is very red, apply a little oil or vaseline to 
allay the irritation. If another poultice is not to be 
applied immediately cover the spot with a piece of 
flannel or a pad, made of absorbent cotton quilted 
between two layers of gauze, the same size and shape 
as the poultice. 

Flaxseed Poultice. — A flaxseed or linseed poultice 
is made in the same manner as the mustard poultice 
except that the mustard is omitted. 

Digitalis Poultices. — To make a digitalis poultice: 
Soak digitalis leaves — two ounces to the pint — in 
warm water, until they are soft, drain off the water 
and boil them. Then proceed as for an ordinary 

i To spread the poultice a small board or platter can be 
used, and time will be saved if a towel is first placed upon the 
board then the oiled muslin, and above that the muslin. 
When the poultice is finished roll in the towel, and wash all 
utensils used before leaving to apply the poultice. 



136 Practical Nursing 

linseed poultice. Add the boiled leaves just before 
spreading the poultice on the muslin. 

Digitalis poultices are applied to the lumbar 
region, in nephritis and other kidney diseases, to 
stimulate the secretion of urine. 

Turpentine and Fomentations or Stupes. — 
Turpentine, when used as a counter-irritant, is 
usually applied as an addition to fomentations 
(stupes) . It is mixed with oil in proportions varying 
from equal parts of oil and turpentine to four of oil 
for adults, and one part of turpentine to from six 
to ten of oil for children. Put this mixture over 
the prescribed area and apply the stupes. Make 
as many applications of the turpentine after every 
two or three stupes, as the skin will bear. 

To Apply Stupes. — When about to apply stupes, 
have, if possible, a gas or alcohol stove near the bed, 
on which to place a dish of boiling water. Get ready: 
two pieces of thick soft flannel 1 twice the size of the 
area of application, a towel, 2 a protector, 3 and, if 
the stupes are for the abdomen, an old blanket with 
which to cover the trunk. When these articles are 
all ready, double the stupe flannel and roll it in the 
wringer. Dip it into the boiling water, and, when 
the water has penetrated to the centre, remove it 
and wring it out well by twisting the two dry ends of 
the towel or wringer in opposite directions. Wring 
very dry, or the patient will surely be blistered and 
the bed made damp. Open the towel, take out 

1 An old blanket is best. 

2 In the hospital, a special crash towel, known as a stupe 
wringer, is provided. 

3 Oiled muslin or oiled paper is the best, but a piece of dry 
flannel will answer the purpose. 



Counter-irritants 1 3 7 

and shake the flannel quickly (to incorporate air) and 
pass the doubled fold under the protector. Fold the 
bed-clothes down to the edge of the blanket which 
covers the trunk. Slip the protector under the 
blanket, upon the area of application, and apply and 
remove the stupes without displacing the blanket — 
thus saving exposure of the patient. 

Stupes, when used to reduce tympanites, are as 
a rule changed every two or three minutes, during 
ten or fifteen minutes of the hour. In other cases 
they are changed every ten or fifteen minutes during 
several hours. After stupes have been applied, it is 
well to cover the spot on which they have been placed, 
as after the application of a poultice, with flannel or 
a pad made of absorbent cotton. 

Fomentations for the Eye. — When applying fomen- 
tations to the eyes, the pieces of flannel must be of 
very light weight. For this reason, absorbent cotton 
or surgeons' lint are often preferred to flannel. When 
there is any suppuration, the same compress must 
never be applied twice, neither must both eyes be 
covered with the same compress. The compresses 
should be small — about two inches square. 

Fomentations of the Breast. — When applying fo- 
mentations to the breast, cut a hole in the centre of 
the flannel for the nipple, as it must never be covered. 

Iodine. — Tincture of iodine is frequently employed 
as a counter-irritant. It is painted on both the skin 
and the mucous membranes. To apply iodine, use 
a camel' s-hair brush or a swab of cotton rolled round 
a small stick. Never put the brush into the bottle, 
but pour a little of the tincture into a medicine glass. 
Apply either one or two coatings, according to the 
amount of irritation required, allowing the liquid to 



138 Practical Nursing 

dry between applications. If the irritation proves too 
severe, wash the surface with alcohol, ammonia, or oil. 

Ammonia. — Ammonia is occasionally used as a 
counter-irritant. Saturate a small piece of linen, 
gauze, or absorbent cotton with ammonia. Apply 
to the required spot and cover with oiled muslin, 
binding the cover on so as to exclude the air. Leave 
the ammonia application on for about five minutes 
unless a blister is desired. If a blister is desired leave 
it on for about ten minutes. 

Chloroform. — Chloroform is sometimes used in 
the same manner. 

Liniments. — There are many liniments, containing 
irritating substances, which are frequently used as 
counter-irritants, to allay muscular pain. The ma- 
jority of these are applied by being well rubbed in 
with the hand. The part should first be washed 
with hot water, in order to remove all secretions from 
the skin and increase the blood circulation in that 
part, thereby hastening absorption. 

Guaiacol and Glycerin. — A mixture of guaiacol 
and glycerin is painted on with a camel' s-hair brush 
or pledget of cotton. It should be applied very thin, 
as it blisters easily. After the application the part 
should be covered with gauze or absorbent cotton 
and bandaged. 

Cupping. There are two kinds of cupping, wet 
and dry. 

Dry Cupping. — Dry cupping is usually employed. 
In the hospital glasses with rimmed edges, specially 
fabricated for cupping, are generally provided; but 
almost any small glasses 1 will answer the purpose. 

1 About six glasses are required. 



Counter-irritants 1 39 

The requisites for cupping, in addition to the glasses, 
are: Matches, a glass containing alcohol, a spirit lamp, 
a metal rod with a swab of cotton rolled around the 
top, extra cotton, an extra glass in which to 
throw the charred swabs, a piece of gauze or soft 
towel, and a blanket. Before beginning the cupping, 
double this blanket and put it, open end to the top, 
under the patient's head and back, fold one end 
over his hair and turn back the spread and upper 
sheet leaving the bed blanket exposed. The patient 
being thus surrounded with the blanket, the danger 
of fire is minimised. As a further precaution against 
fire, the lamp should stand between the patient and 
the alcohol. To do the cupping: Dip the swab in the 
alcohol, ignite it in the flame of the lamp, hold it in 
the glass for a few seconds — till the heat has ex- 
panded and driven off the air — then place the glass 
quickly on the flat surface of the body, bony promi- 
nences being avoided. Repeat this procedure till 
the prescribed area is covered with glasses. The 
tissue under the glasses is drawn up to fill the vacuum 
made by the expulsion of the air. Watch the tissue 
under it and as soon as it becomes a deep red, 1 remove 
the glass by inserting one finger under the rim. 
Never pull a glass off without inserting the finger, as 
to do so causes unnecessary pain. Wipe the glass 
with a gauze compress or a soft towel before reapply- 
ing. Never put a glass in the rim left by a former 
one. In order not to burn the patient, take care 
not to get on the swab enough alcohol to drip, not to 
have the edges of the glasses too hot, and not to use 

1 If the glass be left on too long till the capillaries become 
congested the object of the cupping is defeated. 



Ho Practical Nursing 

a swab till it becomes charred, since the charred ends 
are likely to fall off. Always stand facing your 
patient while cupping, that you may observe any 
change in his condition. 

Cupping is generally continued for ten to fifteen 
minutes at a time. It is principally employed for 
the relief of dyspnoea, oedema of the lungs, and con- 
gestion of the kidneys. 

Wet Cupping. — Before wet cupping is begun the 
surface to be cupped is shaved and washed with green 
soap, alcohol, ether, and bichloride, and the doctor 
makes four or five incisions with a scarificator or a 
scalpel. The cups are placed over these cuts, and a 
small amount of blood is drawn from them. After 
the removal of the cups, the surface is washed with 
salt solution or sterile water, and a dressing of sterile 
gauze is applied. In other respects, the procedure 
is the same as for dry cupping. 

The Actual Cautery. — Cauterising is the appli- 
cation of heated metal to some part of the body. 
Pacquelin's thermo-cautery is the instrument gener- 
ally used in the hospital for this purpose. The 
newest style consists of a hollow platinum tip that 
screws into a metal tube, on the end of which rubber 
tubing (provided with two bulbs, one of soft rubber 
covered with netting, to prevent its too free expansion, 
and another of harder rubber) is fitted. When the 
thermo-cautery is about to be used a small sponge 
which is in the metal tube is soaked with benzine. 
The platinum tip is then held in a flame, and the hard 
rubber bulb is squeezed till the tip becomes red. It 
may be kept hot till needed by gently squeezing the 
bulb at short intervals. 

Be careful not to let the platinum tip come in 



Counter-irritants 14 1 

contact with anything while it is hot, for not only will 
it burn whatever it touches but it will itself easily 
become dented and spoiled. If there are any particles 
of tissues, adhering to it, after use, they must be 
burned off, by bringing it to a white heat. Xever 
cool it by putting it in water. 

The cautery is used as an escharotic, notably to con- 
trol haemorrhage, 1 and to counteract the effect of stings 
of poisonous insects, the bites of mad animals, etc. 
It is also used for the relief of pain in torticollis, 
lumbago, and other forms of muscular rheumatism. 
When used for the last-named purpose, however, 
the implement is not, as a rule, allowed to touch the 
body, but is passed quickly too and fro near the sur- 
face of the skin, till the skin is well reddened. 

A flat iron is sometimes substituted for the cautery 
for the relief of pain in lumbago, etc. A thick piece 
of brown paper is placed upon the part of the body 
affected, and the iron is passed lightly to and fro over 
this, until the skin is well reddened. 

Vesicaxts. — Vesicants are used when a prolonged 
irritation is desired, and to cause the absorption or 
removal of inflammatory deposits after true in- 
flammation has ceased. 

Caxtharides. — Cantharides 2 is the usual vesicant. 
It is employed either in the form of a plaster or of a 
solution of cantharides powder in collodion. 

A definite order regarding the area to be covered 
should be obtained from the doctor. This area should 
seldom exceed three inches square. Otherwise, not 
only will the resulting sore be unnecessarily large, 
but too much cantharides may be absorbed into the 

1 In certain abdominal operations, for example. 

2 See Materia Modi: a. 



142 Practical Nursing 

system and an acute nephritis or strangury ensue, 
cantharides having a very irritative effect on the 
kidneys. For this reason, the urine should be watched 
and measured for twenty-four hours after its use. 

Before applying cantharides, prepare the skin by 
shaving and by washing with water and green soap, 
and alcohol, bichloride or other disinfectant. 

Application of the Plaster. — When the plaster is 
used, lay it on the skin and hold it in place with a 
bandage. Never use adhesive plaster nor put the 
bandage on tightly, or there will not be sufficient 
space for the blister to rise, and unnecessary pain 
will be caused. 

If the plaster is not perfectly fresh, oil its surface 
before applying. 

Never apply a plaster over broken or abraided skin. 

The average time required for the blister to rise 
is four to eight hours. Even if it has not formed at 
the end of this time, remove the plaster and apply a 
hot poultice. The heat of the poultice will generally 
bring about the desired result. 

Removal of the Plaster. — In taking off the plaster, 
be careful not to tear the skin. Clean off any ad- 
herent particles by washing gently with oil. Unless 
it is desirable to have the liquid reabsorbed, make 
a puncture in the bulb at its lower edge with a pair 
of sterile scissors, and hold a piece of sterile gauze 
or absorbent cotton so that it will catch the escaping 
liquid. Apply a dressing of boric acid ointment or 
oxide of zinc spread on lint or gauze. The wound is 
generally dressed every day, the dead skin being 
taken off as it loosens. If aseptic precautions are 
taken, the wound will heal without the formation 
of pus, and will leave no scar. 



Counter-irritants 1 43 

Cantharidal Collodion. — When cantharidal collo- 
dion is to be applied, prepare the surface as for the 
plaster and outline with oil the space to be painted, 
in order to prevent the spreading of the vesicant. 
Cover the prescribed surface with one layer of collo- 
dion (a camel's-hair brush is the best applicator), 
and this in its turn with a piece of lint or gauze and 
oiled muslin or rubber tissue. Treat the resulting 
blister in the same manner as that from the plaster. 

Local Applications other than Counter-irritants 

The Local Application of Cold. — The local 
application of cold is in many cases of inflammation 
a valuable substitute for counter-irritants. Unlike 
moist heat, it retards instead of accelerating sup- 
puration, and its action is more penetrating than 
that of dry heat. Cold is applied locally with two 
objects in view: (i) to cause localised contraction of 
the blood-vessels, thus relieving congestion; and 
(2) to anaesthetise or benumb the nerve-fibre. 

Instruments for the Application of Cold. — 
The most common instruments for the local appli- 
cation of cold are ice poultices, ice-caps, ice coils, and 
ice compresses. 

Ice Poultices. — To make an ice poultice: Cut two 
pieces of oiled muslin the required shape and size, 
place them together and turn over the edges about 
an eighth of an inch all round. Bind with adhesive 
plaster leaving unbound a small section at the top 
till the ice has been put in. Fasten the corners 
securely, strengthening them with extra pieces of 
adhesive plaster. Mix the ice after breaking it into 
pieces the size of a walnut, with one-third as much 
flaxseed or bran, which will absorb the water as the 



M4 Practical Nursing 

ice melts, and with a small amount of salt, which will 
intensify the cold. 

Cover the poultice with gauze before applying, and 
hold it in place either with a binder or a four-tailed 
bandage, as the position requires. 

Ice-Caps. — These are bags of india-rubber. There 
are various shapes, long narrow ones for the neck 
and spine, helmet-shaped for the head, round and 
oval ones of varying sizes which can be used for 
any part of the body. Bladders, which can be bought 
at any butcher shop can be used as a substitute. 
To fill an ice-cap : Break the ice into pieces about the 
size of a walnut. Expel the air from the cap by 
rolling up its ends, and fill it only half full of ice. 
Cover it with gauze or other protector, squeezing it 
above the ice before putting on the cover. The 
weight of the cap often irritates the patient, and, 
when such is the case, the nurse must improvise some 
way of suspending it above the required spot, so that 
it will barely rest there. After use, dry the cap well, 
and put it away with a piece of gauze or cotton in the 
bottom. This is done to prevent the sides from 
sticking together. 

Ice Coils. — Ice coils are coils of rubber tubing a 
quarter of an inch in diameter, held in a circle by 
means of rows of tape. There are two loose ends 
which make the tubing act as a siphon. To use the 
coil, attach the end coming from the centre to a 
special tank, or, in the absence of tank, put it into 
a pan of ice water placed about three feet higher 
than the patient and let the other end fall into an 
empty slop jar at the side of the bed. To start 
siphonage from the pan of water, fit a funnel into the 
upper end of the tubing, fill this funnel with water, 



Counter-irritants H5 

and, before it has all run through, turn the funnel 
quickly into the pan of water. The regular tanks 
have faucets at their lower edge, to which the tubing 
fits, and siphonage starts naturally. 

Before applying the coil, wrap it in a piece of gauze. 

The ice in the tank or pan should always be wrapped 
in doubled gauze or old muslin, to prevent foreign 
particles from entering and obstructing the tubing. 

Compresses for the Head. — A common way of 
applying cold to the head is by means of ice com- 
presses. To make an ice compress: Fold two pieces 
of gauze, half a yard square, or old handkerchiefs, so 
that they will not be wide enough to wet the hair or 
come down over the eyes, nor long enough to wet the 
pillow. Turn in the raw edges, that threads may 
not annoy the patient. Place a block of ice, with 
a very little water, in a small basin, wring out the 
gauze in the water, and spread it over the ice till 
cold. One compress should always be kept on the 
ice while the other is on the head. 

Compresses for the Eye. — A compress for the eye 
should be made of a piece of lint, or three or four 
thicknesses of gauze, cut a little larger than the eve. 
They must never come over the bridge of the nose. 
If compresses are ordered for both eyes, a separate 
one should be prepared for each. When there is 
any discharge from the eye, the same compress must 
never be used twice, and a proper receptacle must be 
at hand into which to throw the discarded compresses. 

Antiphlogistine. — Antiphlogistine, as its name 
implies, is an antiphlogistic. Its composition — 
beyond the fact that it is a variety of Denver mud 
with certain medicinal ingredients incorporated — 
is unknown, except to the compounder. To use 



146 Practical Nursing 

antiphlogistine, spread it about a quarter of an inch 
thick on a piece of old muslin of the required size, 
placed on a tray or plate, and put in a warm oven 
or under the flame of a gas-stove, till the surface 
of the antiphlogistine is heated. Apply and leave 
on for several hours. Wash the skin with soap and 
warm water after removing. 

Starch Poultices. — Starch poultices are often 
used in skin diseases. To prepare a starch poultice, 
mix the starch with a little cold water, then add 
enough boiling water to make a thick paste, boil for 
a couple of minutes and spread the paste. Apply 
the starch poultice in the same manner as the mustard 
sinapism. 

Ointments. — Ointments are applied either spread 
on lint or muslin and kept in place by a bandage, or 
by inunction. The former method is adopted when 
the skin is broken. When the latter method is 
employed, wash the skin first with hot water, to 
soften it and make absorption quicker, and rub the 
ointment in with the heel of the hand, rather than 
with the fingers. If mercurial ointment is used, pro- 
tect the hand with a rubber glove, or you may become 
salivated. Furthermore, as there is generally a sus- 
picion of syphilis, when mercurial inunction is ordered, 
it is well to take every precaution against infection. 

Leeches. — Leeches are not now employed as much 
as formerly, but they are resorted to occasionally, 
especially to relieve congestion around the eye and 
ear, and from the os uteri. 

Leeches can abstract as much as half an ounce of 
blood at a time. They should never be placed over 
large blood-vessels, but rather over bony surfaces, 
where pressure can easily be made in case of haemor- 



Counter-irritants 147 

rhage. To apply a leech, first wash the skin with 
soap and water, and dry it well. Place the leech in a 
small glass test-tube, or bottle, with its head to the 
opening, and invert the glass over the required spot. 
If the leech does not take hold readily, prick the 
spot with a needle to draw a drop of blood, or stroke 
its back with a dry towel. When the leech is full, 
it will drop off. If it is necessary to take it off sooner, 
sprinkle a little salt on its tail. Do not force it off, or 
its teeth may be left in the wound and serious in- 
flammation result. After the removal of the leech, 
the bleeding can be increased, if necessary, by the 
application of hot poultices, or can be checked by 
pressure over the wound, by the application of ice, 
or by touching with nitrate of silver. 

Leeches should be kept in a jar of water with a 
little sand in the bottom till needed for use. The jar 
should have a perforated cover. After use, the 
leeches should be burned. 



CHAPTER XI 



THE URINE 



Nature of Urine. Normal Urine. Specific Gravity. Quan- 
tity. Meaning of Oliguria, Polyuria, Suppression and, Reten- 
tion. Colour. Reaction. Urea. Uric Acid. Test for Urates. 
Abnormal Constituents of Urine. Albumen. Test for Al- 
bumin. Bacteria. Bile. Blood. Glucose. Fehling's Test for 
Glucose. The Fermentation Test for Glucose. Hemoglobin- 
uria. Pus. Renal or Tube Casts. Urinary Calculi. The 
Collection and Care of Urine Specimens. Catheterisation. 
Bladder Irrigation. 

THE urinary organs are among the most impor- 
tant secretory and excretory organs of the 
body. They are the kidneys, the ureters, the bladder, 
and the urethra. The kidneys secrete a considerable 
portion of the waste matter of the body and dis- 
charge it, in the form of urine, through the ureters 
into the bladder, whence it is periodically expelled 
through the urethra. Urine is secreted from the 
blood in two ways; by transudation, and by the 
secretory action of the cells lining the uriniferous 
tubules. 

Urine is a very complex substance. It contains 
some forty parts of solid matter held in solution in 
nine hundred and sixty parts of water. Some of 
its principal constituents are : urea, uric acid, kreatinin, 
pigments, fat, sulphuric acid, phosphoric acid, chlor- 

143 



The Urine 149 

ine, ammonia, potassium, sodium, calcium, mag- 
nesium, phosphates, aromatic substances (such as 
hippuric acid, indoxyl, and skatoxyl), and two gases 
(nitrogen and carbonic acid). 

Normal Urine 

Normal urine is a yellowish or light amber liquid 
having a characteristic odour, a slightly acid reaction, 
and a specific gravity of 1012 to 1030, 1020 being the 
average. The specific gravity indicates the relative 
proportion of solid matter in the urine. The uri- 
nometer is the name of the instrument used for test- 
ing the weight of the urine. To test: Fill a test-tube 
or urinometer glass three-fourths full of urine. Put 
the urinometer in the glass, making it touch the 
bottom. Release it and wait till it finds the correct 
level. The scale should be read through the liquid 
from below upward. The last mark below the sur- 
face will be the correct specific gravity. The urine 
must always be cold when tested. 

Quantity. — The ordinary capacity of the bladder 
is about one pint. The average amount of urine 
voided during the twenty-four hours, by a healthy 
adult, is from forty to fifty ounces; by a child of 
two to five years, fifteen to twenty-five ounces; five 
to nine years, twenty-five to thirty-five ounces; nine 
to fourteen years, thirty-five to forty ounces. Causes 
likely to diminish the quantity of urine are : the con- 
sumption of a small amount of liquids, free perspira- 
tion, high fever, diarrhoea, vomiting, hyperaemia, 
most cases of nephritis, and the approach of death 

1 By specific gravity is meant its weight as compared with 
distilled water at 6o°F. the water weighing 1000. 



150 Practical Nursing 



in all diseases. Causes likely to increase the quantity 
of urine are: the consumption of a large amount of 
liquids, nervousness, hysteria, diabetes mellitus, dia- 
betes insipidus, convalescence from acute diseases in 
general, convalescence from some cases of nephritis 
and the action of diuretics. 

Oliguria. — Oliguria signifies the voiding of only 
a small amount of urine. 

Polyuria. — Polyuria signifies the excretion of a 
large amount of urine. 

Retention. — In retention, the urine is secreted 
by the kidneys; but, owing to some obstruction in 
the urethra or neck of the bladder, paralysis of the 
bladder, nervous contraction of the urethra, or 
dulling of the senses so that there is no desire to pass 
urine, it is not expelled from the bladder. 

Retention with Overflow. — By retention with 
overflow is meant over-distention of the bladder in 
conjunction with either incontinence or the constant 
voiding of small quantities of urine. Other symp- 
toms are pain and the emission of a dull sound, when 
percussion is applied over the bladder. If there is 
much distention, the outline of the bladder can usually 
be distinctly felt. Such a condition should always 
be reported to the doctor, catheterisation being 
indicated. 

Suppression and Anuria. —Suppression and anu- 
ria are terms applied to cases in which the kidneys 
fail to secrete urine. Anuria is highly dangerous 
to life, as toxic poisoning will ensue, unless it is 
quickly relieved. 

Colour. — The conditions causing variations in the 
quantity of urine are also likely to change its colour. 
When its secretion is diminished, it is generally 



The Urine 151 

highly coloured, the amount of solids being com- 
paratively large. When its secretion is abnormally 
increased, it will be a pale straw colour. Diabetes 
mellitus is a notable exception to this rule. In this 
disease, owing to the presence of sugar, the urine is 
always highly coloured. 

The colour of urine is also changed by: (i) Certain 
drugs. Over-dosing by iodoform, carbolic acid, and 
other coal-tar derivatives, such as salol and guaiacol, 
is always marked by dark smoky urine. Rhubarb and 
senna give a reddish-yellow colour, and santonin, a 
brilliant yellow. (2) The presence of decomposed 
blood pigment, which will render it dark and smoky. 
(3) The presence of bile pigment, which gives a 
greenish tinge, the colour becoming deeper as the 
urine stands. (4) The presence of chyle, which gives 
it a milky appearance due to finely divided fat, 
fibrin and albumin. Chyluria is a symptom of Fil- 
ariasis, a parasitic disease occurring chiefly in tropical 
countries. (5) The presence in excess of many of 
its normal constituents. (6) The presence of bacteria, 
which cause a marked turbidity, especially in alka- 
line urine. (7) The presence of pus, which invariably 
makes it turbid. (8) Alkaline decomposition, which 
also makes it turbid. 

Odour. — As the quantity and colour of urine are 
variable, both in health and disease, so also is the 
odour. Normally, urine, when first voided, has only 
a slight, aromatic odour, due to the presence of certain 
volatile acids. On standing, the odour becomes 
ammoniacal, owing to the rapid decomposition of 
urine when exposed to the air. If urine has an 
ammoniacal odour when first passed, it shows that it 
has decomposed within the body. 



15 2 Practical Nursing 

An odour of sulphurated hydrogen may accom- 
pany the evacuation of an intestinal abscess into the 
urinary tract. 

The odour of urine is also changed by the ingestion 
of certain drugs and vegetable substances. Tur- 
pentine imparts an odour of violets. Asparagus, 
copaiba, sandalwood oil, cubebs, and tolu, all give 
their specific odour. 

Reaction of Urixe. — The normal reaction of 
urine is acid; but it will become temporarily alkaline 
after a hearty meal has been taken or after it has 
stood some time, especially in a warm atmosphere. 
This alkalinity is due to the presence of ammonia, as a 
productof fermentation, andmust be distinguishedfrom 
the alkalinity due to the fixed alkalies of potash or soda. 

To determine the reaction of urine, test it with 
litmus paper. If it is acid, it will turn blue litmus 
paper, red. If it is alkaline, it will turn red paper, 
blue; but if the alkalinity is due to the presence of 
ammonia, the paper will shortly resume its red hue. 

Urea. — Urea is the chief organic substance of the 
urine, constituting one-half of the total amount of 
solids therein. It is the principal component of the 
nitrogenous waste of the body, and, when its elimi- 
nation fails to take place, its accumulation in the 
system leads to toxic poisoning and death. Though 
eliminated by the kidneys, the urea is formed chiefly 
in the liver and, probably, to some extent, in the 
spleen, lymphatic and secreting glands. 

The amount of urea in the urine is increased by 
strenuous exercise, 1 hot baths, proteid food, fever 
in its early stages, 2 and a few other diseases. 

1 The last two increase metabolism. 

2 The last three increase tissue waste. 



The Urine 153 

The quantity of urea is diminished by a small 
consumption of proteid food, free perspiration, the 
continued drinking of large quantities of water, 
excessive vomiting, diarrhoea, and by many diseases, 
especially those that involve the kidneys. 

To Detect Urea. — The presence of urea may be 
detected in several ways, of which two of the simplest 
are the following: 

1. Place a drop of urine on a glass slide, add a 
drop of pure nitric acid, and allow the mixture to 
evaporate. If urea be present, crystals of nitrate 
of urea will be visible under the microscope. 

2. To a drop of urine, add a drop of saturated 
solution of oxalic acid. If urea be present, crystals 
of oxalate of urea will be visible under the microscope. 

Uric Acid. — Uric acid is, next to urea, the medium 
by which the largest quantity of nitrogen is excreted 
from the body. It was formerly considered that uric 
acid was an intermediate product between the nitro- 
genous substance and urea; but it is now believed 
that it is formed in the body from nucleic acid, which 
is the product of the oxidation of a certain complex 
constituent of proteid food known as nuclein. 

Uric acid is not usually found in its free state in 
normal urine, but in combination with potassium, 
sodium, ammonium, etc. Such combinations are 
known as urates. The reddish deposit often seen in 
urine, after standing, is due, as a rule, to these urates. 
The presence of this deposit does not necessarily 
mean an excess of uric acid. It may be due solely 
to a high degree of concentration, or a marked acidity 
of the urine. 

Uric acid is increased by an abundant nueleo- 
proteid diet ; by most of the acute diseases, especially 



154 Practical Nursing 

pneumonia, and other diseases affecting the lungs; 
by diseases of the liver and spleen; by certain forms 
of anaemia; and by gout, rheumatism, and diabetes 
mellitus. It is diminished by a non-nitrogenous 
diet; by the drinking of large quantities of water; 
by the majority of chronic diseases; and by all kidney 
diseases in their advanced stages. 

When it is in excess, it occurs in crystals, and these 
crystals often serve as a nucleus for urinary calculi. 

Test for Urates. — To test for urates pour a small 
quantity of nitric acid into a test-tube. Add an equal 
amount of urine, pouring it in gently, so that it will 
not mix with, but just lie on top of the acid. If a 
white ring appears at the point of contact, either 
albumin or an excess of urates is present. To deter- 
mine which, boil the mixture for a few seconds. 
If the precipitate is due to urates, it will disappear; 
but if to albumin, it will increase. 

Crystals. — Other crystals present in urine are 
oxalate of lime, cystin, phosphates, ammonia, and 
magnesium — the last three in alkaline urine only. 
They are precipitated by heat, but will disappear on 
the addition of acid. 

Epithelium. — Epithelial cells from the entire 
urinary tract are usually present in both normal and 
abnormal urine, these cells being but the product of 
the normal waste of the mucous membrane. The 
cells are classified and their origin determined princi- 
pally by their shape. 

Pathologic Constituents of Urinary Sediment 

Albumin. — Albuminuria, the presence of albumin 
in the urine, must always be regarded with suspicion, 
but it does not necessarily indicate renal disease. 



The Urine 155 

It is a frequent complication of many febrile diseases, 
and of pressure on abdominal walls, from tumours or 
a pregnant uterus. Albuminuria of this sort, with 
proper care and treatment, will probably disappear 
after convalescence. 

The most frequent causes of albuminuria are: 
1. Inflammatory or degenerative changes in the 
kidney tructure, which, on account of its abnormal 
state, allows the albumin to transude. 2. Abnormal 
changes in the quality of the blood entering the 
kidneys, which renders its serous albumin more 
diffusible. 3. Alteration in the blood pressure in 
the kidneys. 4. Diseases of the urinary tract below 
the kidneys. 

Heat Test for Albumin. — To test for albumin: 
First, filter the urine. Then, fill a test-tube to one- 
third of its depth, and, if the urine is not acid, render 
it so by adding two or three drops of 10% acetic acid. 
Finally, boil it for a minute, holding the test-tube 
so that the upper part of the urine will boil first. 
Any opacity appearing will be due either to albumin 
or to earthy phosphates If it is due to the latter, it 
will disappear on the addition of two or three drops 
of acetic or nitric acid; but, if to the former, the 
presence of the acid will cause the albumin to be 
further precipitated. 

Bacteria. — Normal urine, while in the body, is 
sterile; but it becomes contaminated in its passage 
through the urethra, that passage, especially around 
the meatus, being seldom absolutely free from germs, 
though many of them are non-pathogenic. This 
fact makes it necessary to resort to catheterisation, 
when a specimen of urine is to be examined for any 
specific bacteria. The germs of tuberculosis, typhoid 



15 6 Practical Nursing 

fever, erysipelas, ulcerative endocarditis, glanders, 
and septic processes are all found in the urine of 
patients suffering from these diseases. 

Bile. — Urine containing more than a minute trace 
of bile is always abnormal in colour, varying from 
a yellow brown to nearly a pure green. Bile pigment 
occurs in urine in all cases of jaundice due to ob- 
struction of the passage of the bile through its proper 
channel, its constituents being then secreted by the 
blood and eliminated through the kidneys. 

Blood. — Blood in the urine — haematuria — always 
indicates a diseased condition of some portion of the 
urinary tract. The most frequent causes are: ad- 
vanced stages of both acute and chronic nephritis, 
active hyperemia, tuberculosis of the kidney or 
bladder, pathogenic growths, urinary calculi, pur- 
pura hemorrhagica, trauma involving the urinary 
organs, and overdoses of certain drugs, such as 
cantharides, turpentine, etc. 

Glucose. — Glucose is often found in normal urine 
after a large quantity of saccharine food has been 
taken. It is also occasionally present, for a short 
time, after recovery from febrile diseases, and may 
occur during pregnancy, after injury to the head, etc*. 
When the presence of glucose is only temporary, 
the condition is known as glycosuria; when persistent, 
it is known as diabetes mellitus. 

Diabetes often complicates diseases of the pancreas 
and, in such cases, is supposed to be caused by the 
prevention of the formation of the glycolytic ferment; 
but the exact causes and nature of diabetes mellitus 
are as yet unknown. 

Fehling's Test for Glucose. — To test for glucose 
with Fehling's solution, add to the solution, drop by 



The Urine 157 

drop, an equal amount of urine. If sugar is present, 
an orange precipitate will appear. Fehling's solution 
consists of equal parts of sulphate of copper and 
tartrate of sodium, and, as it is easily decomposed, 
it is well to test it before adding the urine. To do 
this, dilute it with five times its bulk of water and 
boil; the appearance of any precipitate shows that 
the solution is worthless. 

The Fermentation Test for Glucose. — To 
apply the fermentation test for glucose, place a small 
piece of ordinary baker's yeast in a test-tube full 
of urine, and invert the tube (covering the opening 
with the thumb to prevent the escape of the liquid) 
on a plate of mercury. If any sugar is present, 
fermentation will take place, causing carbonic acid 
gas to accumulate in the upper part of the tube, 
displacing the urine. 

Hemoglobinuria. — Hemoglobinuria is character- 
ised by the presence of blood pigment — derived from 
the haemoglobin of the red blood cells — in the urine. 

Pus. — A few pus cells, or leucocytes may be found 
in the sediment of normal urine, but when they are 
present in any quantity, a pathogenic condition, 
such as chronic suppuration in the tubules, abscess 
of kidney, chronic pyelitis, or urethritis, is indicated. 
In the female, the pus may be from the uterus or 
vagina; this can be determined by obtaining a cat- 
heterised specimen. 

Renal or Tube Casts. — There are several theories 
regarding the origin of renal or tube casts: (i) That 
they are the solidified coagulable elements of the 
blood, which, owing to a diseased condition of the 
renal tubules, have penetrated into them and. have 
afterward been expelled in the urine. (2) That they 



158 Practical Nursing 

are solidified secretions of the epithelial lining of the 
renal tubules. (3) That they are the result of the 
disintegration of the renal cells. 

Urinary Calculi. — Urinary calculi consist of 
deposits of solid matter that have been precipitated 
from the urine. They may form in any part of the 
urinary tract, from the tubules of the kidneys to the 
meatus urinarius. The most frequent causes of 
their formation are changes in the reaction of urine, 1 
the secretion of a smaller amount of water, and an 
increase in the less soluble constituents of the urine. 
They vary greatly in size, shape, and composition, 
the size and shape depending largely on their com- 
position and on their location. 

The Collection and Care of Urine Specimens for 

Analysis 

As food causes many temporary changes in urine, 
that voided in the morning, before food is taken, is 
best for analysis. 

It is a rule in the majority of hospitals that a 
specimen of urine be sent to the laboratory the 
morning after a patient has been admitted to the 
ward, and the morning before and after an operation. 
The reason for the specimen on entering is twofold: 
First, diseases of the kidneys often complicate other 
maladies, and recovery from the renal disturbance 
may depend on its early recognition and treatment. 
Secondly, the condition of the urine is often of great 
diagnostic value. The reason for examination of the 
specimen before an operation is that, under many 
conditions of the kidneys, it is unadvisable to give 

1 Abnormally acid and abnormally alkaline urine tend 
alike to produce calculi. 



The Urine 159 

an anaesthetic, owing to its irritating effects. The 
post-operative specimen is required in order to 
ascertain if the anaesthetic has had any undesirable 
influence upon the kidneys. 

For such specimens, four or five ounces is all that 
is generally required. Before taking a specimen, 
see that the urine glass is perfectly clean. After 
taking the specimen, tie a paper cover securely over 
the mouth of the glass and attach to its neck a tag 
on which you have written the date, the name of 
the patient, the ward, the hour at which the specimen 
was obtained, and the reason for taking it, that is 
whether after the admission of the patient, before 
or after an operation, or for a special examination. 

Sometimes, the whole amount of urine voided 
during the twenty-four hours is required. In that 
case, to determine accurately just how much the 
kidneys are secreting, note the hour the first time 
the patient voids urine. Throw away that urine, 
but save all that he passes subsequently until the 
same hour the next day. A five-pint glass bottle 1 
is a convenient receptacle for urine thus collected. 
The bottle must be perfectly clean, it must stand in 
a cool place, and must be kept tightly corked, other- 
wise decomposition will begin before the end of the 
twenty-four hours. If a sterile specimen is re- 
quired, sterilise the bottle, either by boiling it for 
five minutes or by soaking it in bichloride of mercury 
1-1000 for twenty minutes, rinse it with sterile 
water and plug it with sterile non-absorbent cotton 
(see Chapter II). Sterilise the bed-pan also. When 
it is not in use, keep it filled w T ith bichloride i-iooo, 

1 This bottle can also be made to serve as a measure by 
marking the ounces on a strip of paper or adhesive plaster. 



160 Practical Nursing 

but rinse it with sterile water before use, as bi-chloride 
might alter the nature of the urine. With women, 
it is necessary to use the catheter to obtain a sterile 
specimen. When a specimen from an infant is de- 
sired, bandage a small slim bottle in position to catch 
the urine when voided, adjusting the diaper firmly 
so that it will assist in holding the bottle in place. 

Catheterisation 

There is no part of the human body more easily 
infected than the bladder. Urine decomposes very 
readily under the influence of bacteria, and, if the 
latter are introduced into the bladder, the former will 
further their growth and development, thus starting 
an inflammation of the mucous lining of the bladder. 
This inflammation causes a disease which is known 
as cystitis. Unsterile catheterisation is a channel by 
which germs frequently find entrance to the bladder. 
Hence, the greatest care must be exercised, when 
catheterising, to have everything used in the operation 
perfectly sterile. 

Preparation for Catheterisation. — When about 
to perform catheterisation always have ready two 
catheters, in case one should be rendered unfit for 
use by touching an unsterile surface. Glass catheters 
are preferable for women, being easier to keep clean. 
To prepare the catheters, cleanse them thoroughly 
with soap and water, and then boil them for five 
minutes in a dish kept specially for the purpose. 
Examine them carefully to be sure they are intact, 
take them both to the bedside in the same water 
and basin, placing the basin on a tray and covering 
it and the tray with a sterile towel. In the centre of 
the towel, put a sterile dish containing 2% boric acid, 



The Urine 161 

four sterile gauze sponges, and, when a rubber or silk 1 
catheter is used, some sterile oil with which to lubri- 
cate it before inserting, covering the dish with the 
unused end of the towel. Leave uncovered a corner 
of the tray, on which to put the kidney basin, in- 
tended for the reception of the sponges after use. 
Cover the patient with a sheet, or, if necessary, with 
both a sheet and a small blanket and fold the bed- 
clothes neatly at the foot of the bed. If the patient 
is a woman put her on the douche or bed pan, flex 
and part her knees, drape the lower end of the sheet 
around her legs, gathering it up in the centre to expose 
the vulva only. Then wash and disinfect your hands 
with as much care as though preparing for a surgical 
dressing. 

Manner of Using the Catheter. — To catheterise, 
separate the labia with the thumb and first finger 
of the left hand. Wash the region around the 
meatus urinarius 2 very carefully, and place a fresh 
sponge below the meatus so that, if the catheter slip, 
it will not be rendered unsterile. Be careful, while 
doing this, to keep your fingers on the sponge, so 
that they will not come in contact with any unclean 
surface. Be careful also, while introducing the 
catheter, not to touch the end which is to be inserted. 
Never use force in inserting the catheter, since any 
obstruction will probably be due to a nervous con- 



1 Rubber and silk catheters are cleansed in the same man- 
ner, but the latter should be boiled in corrugated trays, each 
catheter being placed in a separate division and stretched 
full length. The water in the steriliser must be just deep 
enough to cover the catheters, but not to allow them to float. 

2 The meatus urinarius is situated directly above the small 
prominences at the head of the vagina. 



1 62 Practical Nursing 

traction of the urethra, caused by its introduction. 
By waiting a few seconds this will often pass away, 
and the catheter will enter freely. If it does not, 
withdraw it slightly and change its course. So soon 
as the bladder is reached the urine will begin to flow. 
If it ceases to flow, before a reasonable amount has 
been passed, turn the instrument slightly or push it, 
very gently, a little farther into the bladder. 

When the bladder is much distended, do not empty 
it entirely at once, as the sudden collapse of the walls 
might start a cystitis. Draw off sixteen or twenty 
ounces and repeat the process in three or four 
hours. 

While withdrawing the catheter, keep a finger over 
the opening, that the fluid remaining in it may not 
fall on the bed. 

Catheters are cleansed and sterilised after use in 
the same manner, as when being prepared for use. 

The use of the catheter, being fraught with so much 
danger, to the patient, should never be resorted to 
till various expedients, likely to make her void urine 
voluntarily, have been tried. Some of these are: 
the application of hot fomentations or a hot-water 
bag over the bladder; pouring hot water over the 
vulva into the bed pan ; pouring water from one vessel 
into another; or, if near the bathroom, allowing the 
water to run from the faucet. When troubled with 
difficult micturition, the patient should be encouraged 
to drink large quantities of water, especially vichy 
and seltzer. 

The doctor should be told if a patient goes longer 
than ten hours without voiding urine. 

A nurse should always note the character of urine 
before emptying the bed-pan and if there is anything 



The Urine 163 

unusual in its appearance, should save a specimen 
for the doctor's inspection. 

Passing a Catheter upox a Max. — It is a rare 
thing for a nurse to be obliged to pass a catheter 
upon a man, but she should have some idea how to 
proceed, in case of emergency. 

Always use a rubber catheter. 

Raise the penis to an angle of about 6o° from the 
body. Draw back the prepuce. Cleanse the glans 
with boric acid solution, then wrap a small piece of 
gauze around the corona. The gauze covers any 
secretion which may remain and prevents the prepuce 
from slipping back over the glans. Hold the penis 
with the second and third finger of the left hand, 
separate the lips of the meatus with thumb and fore- 
finger and cleanse them. Oil the catheter, and 
introduce it slowly until an obstruction is met, which 
will generally occur even in the normal urethra when 
it has passed in about six inches. AVait fully a 
minute, then make gentle pressure, and the catheter 
will xeadily enter the bladder. A medium size, 
or large catheter is passed more readily than a small 
catheter in normal urethras. 

Bladder Irrigation 

Irrigation of the bladder is sometimes indicated 
in cystitis. Its object is two-fold; to cleanse the 
organ of all abnormal secretions, and to reduce the 
inflammation. The solutions most frequently em- 
ployed for this purpose are normal salt solution and 
boric acid, 2%. They must always be sterile, and 
should have a temperature of ioo°F. to ii5°F. A 
glass irrigator or a small funnel and tubing are needed 



1 64 Practical Nursing 

to introduce the solution. Otherwise, the prepara- 
tions are the same as for catheterisation. 

To Irrigate with a Recurrent Catheter. — 
The patient should always be catheterised before 
bladder irrigation. To irrigate with a recurrent 
catheter, connect the irrigator tubing (which must 
not be longer than eighteen inches) to the straight 
end of the catheter, and allow the solution to run in. 

To Irrigate with Ordinary Catheters. — Glass 
recurrent catheters are hard to procure and metal 
catheters are not generally considered safe, because 
it is impossible to know whether they are perfectly 
clean. Therefore, the ordinary glass or rubber 
catheters are generally used for bladder irrigation, 
the preference being given to the rubber over the 
glass because the former will not move so readily in 
the bladder during the operation. To irrigate with 
an ordinary catheter, proceed as with a recurrent 
catheter until eight or ten ounces of the solution 
have run in. Then, shut off the current, and dis- 
connect the tubing and catheter in order that the 
injected fluid may return. This process is generally 
repeated until the fluid returns clear. 

When a glass irrigator cannot be obtained, it is 
better to use a funnel and tubing, in order that the 
amount of fluid running in may be gauged. In this 
case, it is unnecessary to disconnect the catheter, 
as siphonage can be obtained by lowering the funnel. 



CHAPTER XII 

DOUCHES 

Vaginal, Intra-Uterine, Spinal, Xasal, and Aural Douches. 
Care of Douche Utensils. 

ONE of the simplest and most effective prophy- 
lactic and therapeutic agencies is the douche. 
The principal douches are known as vaginal, intra- 
uterine, spinal, nasal, and aural, according to the part 
of the body to which they are applied. 

Vaginal Douches 

Vaginal douches are given for their cleansing 
effect, for local stimulation, for reduction of inflamma- 
tion, and to arrest haemorrhage. 1 When given for 
either of the last two purposes, they must be very 
hot, i2o° F., and great care must be taken not to 
burn the patient. The temperature of the ordinary 
cleansing douche varies from no° F. to 115 F. Vari- 
ous solutions are employed (the quantity being 
prescribed), normal salt solution and carbolic 1-120 
being, perhaps, the most common. Creolin 10% and 
lysol 5% are frequently resorted to, when there is 
a profuse discharge. 

*It must be remembered that a warm douche, by diluting 
the blood-vessels, would increase the haemorrhage. 

165 



1 66 Practical Nursing 



The appliances necessary for vaginal douching 
are a douche pan, 1 a douche can or bag, 2 and a douche 
nozzle. 3 The nozzle should be boiled before use and 
attached to the rubber tubing of the douche can, 
the can being first filled with the necessary solution. 
When douches are given after an operation, the 
tubing and can must also be disinfected before use. 
To carry these things to the patient's bedside, hang 
the nozzle inside the can, place the can inside the 
pan, 4 and cover the whole with a sheet. 

To administer the douche get the patient into the 
dorsal recumbent posture. Place the douche pan 
in position. Dispose a soft pillow under the small 
of the back of the patient, in such a way that its end 
will come over the end of the douche pan and cover 
the patient with a sheet. Turn down the bed-clothes. 
Twist a corner of the lower end of the sheet around 
each of her feet and the lower part of her legs, gather- 
ing it up in the centre enough to be out of the way 
while giving the douche, but not enough to expose 
her. Place the douche can about three feet above her. 
Insert the nozzle gently, pointing it downward and 
backward. Move it round, while it is in the cavity. 

After use, wash the douche can and pan thoroughly 
with hot water, and dry them well. Wash and boil 
the douche nozzle. 

1 Douche pans are made from three to eight inches high 
Pans of the size last named are used when a large quantity of 
water is required. Vessels of this size also have the advantage 
of raising the pelvis and thereby making the douche more 
effective. 

2 Agate cans or glass irrigators are preferred for hospital 
use. 

3 In cases of perineorrhaphy a glass catheter is often used 
instead of the regular douche nozzle. 

4 The oan should first be warmed. 



Douches 167 

Douches are always best given to a patient while 
she is in bed, and in order to derive the greatest 
benefit from them she should remain there for an 
hour or two afterward. 

Intra-Uterine Douches 

The intra-uterine douche should be given by the 
physician, except in an emergency. The only instru- 
ments required, unless it is to be supplemented by 
other treatment, will be the intra-uterine douche 
nozzle, the bi-valve speculum, and the uterine dress- 
ing forceps. These must be sterilised by boiling 
for five minutes. The other articles necessary are: 
about 12 sterile sponges; 2 sterile towels; lysol 10%, 
(or other serile substance with which to lubricate 
the speculum) ; sterile rubber gloves ; the douche pan ; 
the sheet with which to cover the patient ; liquid green 
soap 50% ; and a disinfectant for cleansing the vagina 
before the introduction of the nozzle into the uterus. 
The solution for the douche, the irrigator or can in 
which this is put, and also the rubber tubing attached 
to it must be sterilised, preferably by boiling. 

Prepare the patient for the intra-uterine douche 
by washing in and around the vagina with green 
soap and a disinfectant. Many physicians order also 
a vaginal douche. 

After the physician has inserted the speculum, he 
generally further cleanses the surface around the 
cervix, and, then, having first let water rim through 
the nozzle to expel the air, inserts its tip gently into 
the uterine cavity until it is felt to touch the fundus. 

The Spinal Douche 

To give a spinal douche when the patient is not 
confined to his bed, have him sit on an unvarnished 



1 68 Practical Nursing 

stool in the bath tub, drape a sheet over his chest 
and around his legs, leaving his back exposed. A 
shower which can be attached to the faucet is the 
best appliance to use, but when this cannot be ob- 
tained, dash water over his back from the pitchers, 
using some force. The affusions are alternately hot 
and cold as a rule and the treatment should be finished 
with massage of the back. 

When the patient is unable to get out of bed, pro- 
tect the bed with a rubber 1 sufficiently large to cover 
it, and to extend into a pail placed at its foot. Make 
the rubber into a trough, by placing rolled blankets 
or pillows, folded and tied, under it, along the sides. 
Elevate the head of the bed. Drape the patient 
(leaving the back exposed) with bath towels, a sheet, 
or an old blanket. Have ready several pitchers of 
water, of the required temperatures. Pour their 
contents slowly up and down the spine. Follow 
with a brisk massage of the spine. A hot-water bag 
at the feet is often desirable. 

Nasal Douches 

For a nasal douche, a small irrigator or fountain 
syringe, a nasal tip, a basin to catch the liquid, a towel, 
and a handkerchief will be required. The tempera- 
ture of the douche solution should be about no° F. 

The great danger in nasal douching is that if im- 
properly performed the discharge will be washed into 
the Eustachian tubes. To prevent this the following 
points must be observed: The irrigator must not be^ 

iWhen a rubber sufficiently large cannot be obtained, two 
or three smaller rubbers may be used. The rubbers should 
overlap each other by three or four inches, the one at the 
head of the bed being always the uppermost. 



Douches 169 

hung more than eighteen inches above the patient. 
The patient must be instructed not to breathe through 
his nose, not to blow his nose while it is filled with 
water, nor to attempt to swallow the water ; he must 
keep his head bent forward, otherwise some of the 
solution will drop from the naso-pharynx into the 
pharynx and in the effort which he makes to dislodge 
it, it may be forced into the Eustachian tube. 

To give the douche, have the patient bend his head 
over a basin and breathe through his mouth, then, 
insert the end of the nozzle in one nostril. The 
solution will flow into the naso-pharynx, around the 
septum, and through the other nostril. When one 
side is thoroughly cleansed the nozzle is inserted in 
the other nostril. 

The Aural Douche. 

The best appliance for douching and washing out 
the ear is the "return aural syringe." To employ 
this syringe, attach to it two pieces of rubber tubing 
a quarter of an inch in diameter and eighteen inches 
long, fitting the tubing, which is to be attached to the 
irrigator, to the straight end where the opening to 
the inside channel is, and the tubing which is intended 
to carry off the return flow, to the side opening. Place 
the other end of the latter in a basin. Fasten a 
dressing rubber and towel around the patient's neck. 

The orifice of the ear is not in a straight line with 
the auditory canal. It is higher in children, and, 
owing to the shrinking of the bones, as they harden, 
lower in the adult. While irrigating, to make the 
canal as straight as possible, hold the auricle of the 
child's ear upward and outward, and that of the 
adult downward and outward. Dry the auditory 



170 Practical Nursing 

canal after it has been irrigated. To do this, make 
small pointed pledgets of absorbent cotton, hold the 
auricle in the proper position, insert a pledget, leave 
it in for a few seconds to absorb the moisture, and 
then remove. Repeat the procedure, using dry 
pledgets each time, till the cotton, when removed 
is perfectly dry. Never put a pointed instrument 
into the ear. 



CHAPTER XIII 



ENEMATA 



Uses and Varieties of Enemata. How to Give Enemata. 
Rectal Irrigation. Care of Rectal Tubes. Examination of 
Faeces. 

A LARGE portion of the waste of the body being 
carried off through the large intestine, it is 
absolutely indispensable that this organ be kept, in 
all respects, in good condition. With this object 
and a number of others in view, various liquids are 
introduced into it by way of the rectum. Liquids 
thus introduced are called enemata. The principal 
enemata, which derive their names from the nature 
of the liquids themselves or the purpose for which 
they are given, are: 

i. Anthelmintic enemata, given to destroy worms. 

2. Antiseptic enemata, given to destroy germs. 

3. Astringent enemata, given to contract the 
tissue and superficial capillaries and used both in 
case of haemorrhage and in certain forms of diarrhoea. 

4. Carminative enemata, given to relieve flatu- 
lence. 

5. Emollient enemata, given to soothe irritation 
of the mucous membrane of the intestine, thereby 
checking diarrhoea, etc. 

171 



17 2 Practical Nursing 

6. Nutritive enemata, given to afford nourishment 
when it cannot be taken by the mouth. 

7. Purgative enemata, given to increase peristal- 
sis and wash out the intestine. 

8. Sedative enemata, given as a sedative, either 
local or general. 

9. Stimulating enemata given for general stim- 
ulation. 

10. Saline enemata given to relieve thirst. 

The articles required for the giving of enemata are : 

1. A sheet or blanket or both, with which to cover 
the patient. 

2. A rubber to protect the bed. 

3. A bed-pan or douche pan. Even when the 
enema is to be retained it is well to have a pan at 
hand. 

4. A dressing towel. 

5. A rectal tube or catheter. The catheter is 
preferable when the enema is to be retained. 

6. An irrigator, douche bag, a funnel, and tubing, 
or a Davidson syringe. 

7. A pitcher or graduate-glass to hold the liquid, 
if the funnel or Davidson syringe is used. 

8. The liquid, which varies according to the nature 
of the enema. 

Method of Giving Stimulating, Nutritive, and Other 

Enemata where Only a Small Amount of 

Fluid is Used 

Quantity of Liquid. — The amount of liquid 
ordered for an enema, unless it be purgative or 
saline, 1 seldom exceeds six to eight ounces. The 

1 The carminative enema in some of its forms is also an 
exception. 



Enemata 



76 



enema, to be of benefit, must be retained and ab- 
sorbed, and it will not be, if the bowel is over- distended 
by the introduction of a large amount of fluid. 

Put the solution in a pitcher or graduate glass 
and stand this in a basin of hot water to keep it from 
cooling while the patient is being prepared. Cover 
with a small rubber. Put this rubber under the 
patient to protect the bed, during the giving of the 
enemata. 

Temperature of Liquid. — Enemata, with the 
exception of those required for stimulation, are 
generally given at a temperature of ioo° F. When 
stimulation is desired, the temperature should be 
higher, namely, iio°-ii2°F., heat, in itself, being 
a valuable stimulant. 

Position of the Patient. — For small enemata, 
the patient is usually placed in the dorsal recumbent 
position (see Chapter XVIII). After placing him in this 
position, cover his chest and abdomen with a folded 
sheet or blanket and turn down the bed-clothes to its 
lower edge. Pass your hand between the two to 
insert the tube without exposing him. 

The Rubber Catheter. — When the enema is to 
be retained, it is well to use a small rubber catheter 
instead of a rectal tube, since its insertion and re- 
moval cause less irritation of the intestine. Lengthen 
the catheter, if necessary, by the addition of ten to 
twelve inches of rubber tubing. Insert a small 
funnel in the free end of the tubing, or, if this is not 
used, in the catheter. 

Manner of Using the Catheter. — To avoid 
getting air into the intestine, and so causing the 
patient unnecessary pain, pour some of the liquid 
to be used into the funnel and allow a portion of it 



174 Practical Nursing 

to run through the tubing and catheter, before in- 
serting the catheter. When medication is used, the 
liquid must run back into the pitcher. Be careful 
while giving the enema never to allow the funnel to 
become empty. Lubricate the catheter well, before 
introducing it, with an emulsion of castile or ivory 
soap. 1 Insert the catheter as far as possible, and 
inject the fluid slowly. Hold a folded towel pressed 
closely to the anus during and for some time after 
the giving of the enema, to insure its retention. 

Remove the catheter quickly, but gently. If, 
however, the enema is not easily retained, remove 
the funnel and tubing, but clamp the catheter and 
leave it for twenty minutes to half an hour. If no 
clamp is at hand, fold the end of the catheter three 
or four times and pin a safety-pin across the fold. 

Carminative Enemata. — The carminative enema 
for the expulsion of gas from the intestines is generally 
given in conjunction with the purgative enema. 
Emulsions of asafcetida and turpentine are the car- 
minatives most frequently used. Turpentine, owing 
to its intensely irritating property, is best made into 
an emulsion with oil or some oily substance. 

To prepare such an emulsion, heat the oil to ioo° F., 
and add the turpentine. This enema is given in the 
manner already described, and the patient should be 
encouraged to retain it for at least an hour. It is fol- 
lowed by a soapsuds enema. If the oil should not 
flow readily through the tube, disconnect the funnel 
and tubing and force the oil through the catheter, 
by means of a glass or metal syringe. 

1 Oil and vaseline may be used, but they soften the tubes, 
make them harder to clean, soil the bed-clothes, and favour 
the propagation of germs. 



Enemata 175 

Emollient Enemata. — The emollient enema in 
most common use is starch. To make a starch 
enema, dissolve one heaping teaspoonful of starch 
in a little cold water, add slowly six ounces of boiling 
water and boil one or two minutes, at the end of which 
time it should be of the consistency of a thick syrup. 
Allow it to cool to 103 F. before giving. When 
opium is ordered, add it just before giving the enema. 
The starch, like the oil, can, if necessary, be forced 
through the catheter with a syringe. 

Nutritive Enemata. — Great care must be taken 
in the preparation of nutritive enemata, as the sub- 
stances generally used, viz.: egg, peptonised milk, 
beef peptones and salt, are very apt to curdle if mixed 
or heated too quickly. The warming is best done 
in a double boiler or a bowl placed in a saucepan of 
boiling water. 

To make a nutritive enema with the above in- 
gredients, heat the milk, add the peptones, which, if 
solid or gelatinous, must be first dissolved or liquefied, 
then the egg, which must be stirred till broken, 1 and 
raise to a temperature of ii5°F. If brandy or 
whisky is ordered, add it slowly to the mixture after 
it has been removed from the fire. 

Peptonized foods which are partly predigested, are 
used for nutritive enemata, because the large intestine 
has no digestive power. 

Patients who are receiving nutritive enemata 
should also be given a daily purgative enema. Other- 
wise, absorption in the large intestine being slow 
and incomplete, there is danger of an accumulation 
of residue which will cause such irritation of the 

1 The egg should never be beaten as too much air would 
thereby be incorporated. 



176 Practical Nursing 

mucous membrane of the intestine, that the chances 
of the retention and absorption of the nutritive 
enemata will be much lessened. 

Purgative Enemata. — The process of digestion 
is completed in the small intestine, whence the 
residue or waste is propelled onward by the peri- 
staltic action of the bowel, into the large intestine to 
be expelled through the rectum. If, for any reason, 
expulsion fails to take place, this waste material 
ferments, decomposes, and forms a toxic substance 
which, unless removed, will be absorbed, and cause 
general poisoning of the system. That the bowels 
should be well regulated is, then, an obvious necessity, 
and catharsis, in some form, must be given when they 
fail to move naturally. 

Purgative enemata are given in the following cases: 
when an immediate action is required, when nausea 
or other ill effects are feared from the taking of 
catharsis by mouth, when a thorough cleansing of 
the intestine is desired, or when the action of ca- 
tharsis is to be furthered by emptying the lower 
bowel. There are several varieties of purgative 
enemata, but the soapsuds enema is the most 
common. To prepare a soapsuds enema: make a 
thick soapsuds by agitating white castile or ivory 
soap 1 in water about no° F, and remove the froth, 
since this contains air and will cause pain if injected. 
Two to four pints will be required for an adult and 
one to one and a half for a child. 

A long rectal tube attached by means of a glass 
connecting-tube and rubber tubing to the douche can 

1 Never use brown or other laundry soaps. They contain 
strong alkalis, and their use is often followed by irritation 
of the mucous membrane of the intestine. 



Enemata 177 

or fountain-syringe bag, is the best appliance for 
the giving of this enema. In using this appliance never 
place the can or bag more than three feet above the 
patient, for, if the water flows in too quickly, there 
will be a too sudden distention of the bowel, re- 
sulting in the immediate expulsion of the enema, 
which, to be of much benefit, should be retained 
fifteen to twenty minutes. Have a stop-cock on the 
tubing to enable you to regulate the flow and to shut 
off the water when required. 

Purgative enemata are often given in the same 
general manner as the other varieties of enemata, 
(see page 171) but the tubing should be longer (24 
inches) and the funnel larger. 

They are also given occasionally with the Davidson 
syringe, an apparatus which has been almost entirely 
superseded by the long rectal rubber tube, because 
the flow of water through the latter is more even and, 
therefore, causes less distress. The Davidson syringe 
is useful, however, when the lower bowel is impacted, 
as the water can be introduced with more force than 
with any other apparatus. To use it: Screw on the 
hard rubber tip. Put the free end of the tube in the 
pitcher of soap-water and, by pressing the bulb, 
force the water through the syringe to expel the air. 
Then, insert the tip in the rectum, or, if the impaction 
is high up, introduce a rectal tube into the intestine, 
and put the tip in the rectal tube. Finally, drive in 
the water by squeezing the bulb slowly and with 
even pressure, never using too much force. 

Never keep the bed-clothes over the patient while 
giving a purgative enema. Cover him with an old 
blanket, slip a rubber sheet covered with one end of 
a muslin sheet (never a fresh one) under the thighs, 



178 Practical Nursing 

flex the knees, and bring the unused half of the sheet 
up over the legs, under the blanket. When possible, 
the patient should be turned on the left side with the 
knees well flexed, as, owing, to the formation of 
the intestines, the water will then have freer entrance. 
When necessary for the patient to remain in the 
dorsal position, the result will be better if the foot 
of the bed can be elevated. 

A douche pan being larger than a bed-pan, there 
will be less danger of soiling the bed if the former is 
used. It should be brought to the bedside with the 
other requisites, before starting the enema, as it may 
be required suddenly. 

Lubricate the tube well before insertion and insert 
it gently. If the rectum is found to be packed, the 
tube must be withdrawn and the faecal matter re- 
moved with the finger. To do this, either cover the 
finger with a rubber cot, or imbed the nail in soap. 
This is necessary not only to prevent faeces from 
getting under the nail, but also to prevent the 
nail from scratching the mucous membrane of the 
intestine. 

Never use force in introducing the tube. Ob- 
struction will probably be due to one of the three 
following causes: 

1. A nervous contraction of the intestine, which 
will pass away in a few seconds. Wait until it does 
pass away, since the application of any force might 
injure the mucous membrane of the intestine. 

2. Impaction higher than the finger can reach. 
To deal with this, let a little water run in, and push 
the tube in farther as the impaction, softened by the 
water, diminishes. 

3. The clogging of the rectal tube by faeces. To 



Enemata 179 

remedy this withdraw the tube and let the water run 
through it. 

The tube can be inserted as far as it will go without 
force. Let the water run in slowly. If much pain 
ensues, shut the water off, occasionally, for a minute. 
When a sufficient quantity has been introduced, 
remove the tube quickly but gently, and press a 
folded towel to the anus, for a few minutes. 

No alarm need be felt if the water is not expelled, 
as it is often absorbed, especially if the patient is 
thirsty. In such cases the enema should be repeated 
in about an hour. If the second injection is not 
expelled, siphon back the liquid in the following 
manner: Put the patient on the douche pan, insert 
the rectal tube with a funnel attached, fill the funnel 
with water, and, before it has all run through, lower 
and turn the funnel into the pan. 

The result of the enema should always be charted 
or reported to the doctor. 

Abdominal Flushing. — In cases of obstinate 
constipation, it is sometimes necessary to flush the 
colon more thoroughly than can be done with the 
patient in the usual positions. The knee-chest po- 
sition is then adopted. The patient, as the name 
of the position implies, rests on the knees and chest, 
the head on one side, the arms at the sides — never 
under the chest. A nurse must support the patient 
and watch the pulse carefully, for the position is a 
trying one. 

Medicated Purgative Enemata. — Various drugs 
with laxative properties, such as Rochelle Salts and 
Fel Bovis, are often used as enemata. The salts are 
generally given dissolved in a small amount of water 
(about six ounces) and should be retained. Fel 



180 Practical Nursing 

Bovis, as a rule, is added to the ordinary soapsuds 
enema. 

Glycerin is often given, generally with oil, for the 
purpose of softening impacted faeces. The glycerin 
exerts, besides, a strong laxative action and possesses 
the property of extracting fluid from the tissue. 

Stimulating Enemata. — Whisky or brandy and 
salt solution are the most common ingredients of 
stimulating enemata. After giving a stimulating 
enema, watch the pulse to see if it has produced the 
desired result. 

Sedative Enemata. — Chloral and bromide are the 
drugs most commonly used for sedative enemata. 
Before administering a sedative enema, make the 
patient comfortable and give all impending treat- 
ment, that, after the enema, he may be left undis- 
turbed. 

In localities where the water supply is doubtful, 
the water for enemata should be boiled. 

Rectal Irrigation. — Rectal irrigation is the in- 
troduction into the intestines of a large amount of 
fluid, the greater part of which is immediately ex- 
pelled, although a considerable amount is absorbed, 
of course, when the irrigation is continued for some 
time. Rectal irrigation is used principally: 

(i) As a substitute for purgative enemata, es- 
pecially when no result can be obtained from the 
latter; (2) for general stimulation, to take the place 
of intravenous injection; (3) as a diuretic. 

The irrigation is continued for from half an hour 
to several hours. Normal salt solution or plain 
hot water of a temperature varying from 105 to 
1 1 5 are the liquids most commonly used. 

About the same articles are required for a rectal 



Enemata 



181 



Kemp Tube 



irrigation as for an enema. A long piece of tubing 
to carry off the return flow of the liquid, and a 
receptacle to catch it will also be needed. 

Special tubes, such 
as the Dixon and 
Kemp, are frequently 
used instead of a 
rectal tube. They 
both consist of two 
cylinders, one inside 
the other, each of 
which has an open- 
ing and a pipe at- 
tached. In both 
varieties of tubes the 
straight attachment 
is the one through 
which the ingoing 
liquid flows. There- 
fore, attach the tubing connected with the irrigator 
to it and the tubing intended to carry off the return 
current to the curved pipe at the side. Put the 
other end of the latter into a receptacle on the floor. 
Lubricate the cylinder well before inserting it in the 
rectum. Two rectal tubes or catheters are very 
frequently used instead of the above tubes. In 
using them, always introduce the one attached to the 
tubing connected with the irrigator an inch farther 
into the intestine than the one intended for the return 
flow. 

By all of these methods, the liquid is made to 
flow in and out evenly and uninterruptedly. 

When the irrigation is to be continued for only a 
short time, a single rectal tube is sometimes used. 




1 82 Practical Nursing 

In this case, the return flow is obtained in the following 
manner: Insert the base of a T tube in the rectal tube. 
Attach the tubing connected with the irrigator to one 
arm of the T and the tubing intended for the return 
flow to the other arm. Put a stop-cock on each 
tubing and insert the rectal tube in the rectum. 
While the water is flowing in, keep the stop-cock on 
the tubing for the return-flow closed until about 
half a pint has entered. Then, open this stop- cock 
and close the other, that the water introduced may 
return. Repeat the process as often as required. 

To estimate the quantity of liquid given at a time, 
it is necessary either to use a glass irrigator or to 
attach a funnel to the tubing and pour the fluid 
from a pitcher. 

The position of the patient is the same for irrigation 
as for enemata. 

When giving irrigation, always protect the bed 
with a rubber covered with a folded sheet, or, if the 
anus is relaxed (as is frequently the case with a 
patient who is very ill), substitute for the rubber a 
Kelly pad or douche pan. Elevate the foot of the 
bed, when possible. Place the irrigator three feet 
above the patient. There are large irrigators special- 
ly designed for rectal irrigation, but when these can- 
not be had the ordinary irrigator, douche can, or bag 
may be used and refilled as often as necessary. 
Never allow all the water to run out of the irrigator 
before refilling. 

Care of Rectal Tube. — After using a rectal tube, 
cleanse it of faecal matter, allowing first cold l water 

1 As all discharges from the body contain albumin, if hot 
water is used first the albumin will be coagulated and 
harder to remove. 



Enemata 183 

to run over and through it, then, hot water. Cleanse 
further with soap and hot water. Boil five minutes 
in a i% solution of sodium chloride. 1 

Examination of Faeces 

The character of the faeces being an index of the 
condition of the whole lower portion of the alimentary 
tract, all evacuations of the Dowels during illness 
should be inspected before being emptied. 

Curds of milk in stools indicate imperfect fermen- 
tation in the stomach. Oil in the dejections is 
probably caused by defective action of the liver, 
pancreas, or intestinal glands, in consequence of 
which fatty substances in the food are not emulsified. 
Black, tarry stools may mean the presence of digested 
blood, or may be due to certain medicines such as 
iron and bismuth. Greyish dejections indicate an 
absence of bile. Greenish dejections indicate the 
presence of bile in undue proportion, and with chil- 
dren show an altogether defective digestion. Green- 
ish-yellow liquid evacuations point to typhoid. 

Mucus may indicate enteritis, 2 and pus, an opened 
abscess. Blood may proceed from haemorrhoids, 
but may also be caused by ulceration of the intestines. 
Watery stools are associated with diarrhoea, but are 
also the natural result of hydragogue cathartics. 

Hard lumpy stools indicate constipation. 

When examining stools for worms, 3 calculi, etc., 

1 Salt in the water prevents the rubber becoming softened 
as it will otherwise become by being soiled. 

2 Worms are sometimes mistaken for shreds of mucus. 

3 The worms most frequently found in the faeces are the 
"oxyuris vermicularis, the thread or seat-worm" (a fine 
white worm |-| of an inch in length) and the "cestodes or 



184 Practical Nursing 

tie thin muslin over a chamber, empty the bed-pan 
into this, and pour water over it slowly, breaking 
up all lumps of faeces with a stick. This should be 
done in a good light, since it is often difficult to detect 
the foreign matter. 

Odour of Faeces. — The odour of faeces is also 
important. A very foetid odour, unless due to medi- 
cation denotes extreme decomposition within the 
body. This decomposition is frequently due to lack 
of bile, the great natural disinfectant of the system. 

tapeworms" (long flat worms, pieces of which are often 
mistaken for shreds of mucus). When examining tapeworms 
always see if the head has been expelled, as, otherwise, the 
worm will grow again. 



CHAPTER XIV 

LAVAGE, ETC. 

Lavage. Gavage. Xasal Feeding and Feeding after Intuba- 
tion. Test Meals. 

LIQUID is often introduced, by means of a tube, 
into the stomach, also, with a number of 
objects in view. 

Lavage 

Lavage is the washing out of the stomach. It is 
performed for the evacuation therefrom of poisons 
and of irritating matter which is causing nausea; 
and, in certain diseases of the stomach, for the 
cleansing of its lining. 

The articles required will be: 

i. The stomach tube, lengthened, if necessary, 
by rubber tubing. 

2. A funnel. 

3. A slop jar. 

4. Two rubbers — one to protect the floor, the 
other to protect the patient. 

5. A towel. 

6. A kidney basin, in case the patient is nauseated. 

7. Two pieces of gauze — one for the patient to 
use as a handkerchief, the other for wiping the tube. 

8. Two pitchers of hot water — one 105 F., the 
other, 1 1 5 F. 

185 



1 86 Practical Nursing 

9. A basin containing ice, round which the 
stomach tube is rolled. 1 

ic. A cork with a hole through the centre through 
which the tube can be passed, or a spool or a piece 
of rolled bandage, to put between the teeth. This 
device is not necessary when the patient is accustomed 
to the passing of the tube, but otherwise it is a wise 
precaution, as he is liable to bite the tube. 

Before starting the treatment, it is very important 
to reassure the patient and gain his confidence, for, 
with his assistance, it is a very easy matter, while 
without it, it is likely to be a very trying one. 

To perform lavage: Attach the funnel to the tube. 
Insert the tube gently, since any force might result 
in the perforation of the mucous membrane of the 
oesophagus. Make the patient swallow, if possible, 
since swallowing will greatly facilitate the insertion. 
Avoid striking the back of the pharynx, as that will 
cause nausea. The length of tube to insert depends 
upon the size of the patient. Estimate the distance 
from the mouth to the stomach, and allow an extra 
couple of inches for the mouth. Fill the funnel with 
water and allow it to run through the tube until only 
half an ounce remains in the funnel. Repeat the 
procedure until a pint has been introduced into the 
stomach. 2 Then, lower the funnel into the slop 
jar and the fluid will siphon back. Introduce water 
and siphon it back several times. If there is any 
sign of blood in the ejected water, discontinue the 

1 The cold hardens the rubber and this makes it easier 
to swallow. 

2 Never allow the funnel to become quite empty, as air would 
thereby be introduced causing unnecessary distress, and 
interfering with the siphonage. 



Lavage, Etc. 187 

treatment until the fact has been reported to the 
physician, for. if there is a possibility of haemorrhage 
due to a diseased condition of the stomach, lavage 
might be dangerous. 

In charting the result of the lavage, state how much 
water was required before it returned clear, and 
whether mucous or other abnormal secretions were 
present in it. 

Gavage 

Gavage is the introduction of liquid food into the 
stomach through the stomach tube. 

To perform gavage, introduce the tube as for 
lavage. Allow a few seconds to elapse after its 
insertion before pouring in the liquid. Muscular 
contractions are sometimes started in the stomach by 
the insertion of the tube and these may cause the 
immediate expulsion of the liquid if it is put in before 
they have quieted. Pour the liquid in slowly, and 
withdraw the tube quickly, but gently. 

Xasal Feeding. — When the patient is in a state 
of coma, is unmanageable, or has had an operation 
in the throat or mouth, the liquid is often introduced 
through the nose by means of a rubber catheter. 

The insertion of the tube is easier in this way than 
through the mouth, but there is considerable danger 
of getting it into the trachea. Watch the patient's 
colour, after inserting the tube, 1 and, if he becomes 
cyanosed, withdraw the tube. If he does not, it is 
generally all right. To make sure, however, put 
the funnel to your ear, before pouring in the liquid, 
and listen a minute. If the tube is in the trachea, 
you will hear a whistling sound. This must not be 

1 Direct the tube horizontally when inserting it. 



1 88 Practical Nursing 

confounded with the gurgling sounds that are heard 
when the tube is in the oesophagus. Another thing 
that may happen, and that must be guarded against 
is the curling up of the tube in the mouth, if it does 
not find its way into the oesophagus. 

When there is any difficulty in inserting the tube 
in one nostril, remove it and try the other nostril. 
The septum in the majority of people is not perfectly 
straight; hence, one nostril is usually larger than the 
other. 

To give any of these treatments to children, re- 
straint is generally required. The best way to obtain 
this is to roll a blanket tightly around the body and 
arms in such a way as to keep the latter straight 
at the sides. 

Feeding after Intubation. — When feeding a 
patient after intubation, raise the foot of the bed. 
It is easier to swallow, after this operation, if the 
head is lower than the body. 

Test Meals 

In diseases of the stomach, diagnosis is much 
facilitated by the giving of certain recognised "test 
meals," and then, at a specified time, withdrawing 
the contents of the stomach by siphonage and 
examining the same. 

Thus, the motor function of the stomach can be 
ascertained by knowing how long it takes to com- 
pletely empty itself after receiving certain food, and 
the reaction of the gastric juice can be determined 
by testing the result of the siphonage with litmus 
paper. The absorbing power of the stomach, like- 
wise, is sometimes arrived at by giving the patient 
potassium iodide and then testing the saliva every 



Lavage, Etc. 189 

five minutes with starch-paper and acid. If ab- 
sorption is normal, iodine will appear in the saliva 
within fifteen minutes (see Chapter XXIV . 

Some hours before a test, meal is taken lavage is 
generally performed and nothing is given by mouth 
afterward, except the special food, until after the 
siphonage. 

The test meals in most common use are: 

1. Two small slices of very dry toast (no butter; , 
and six or eight ounces of weak tea (no milk or sugar). 
It is withdrawn by siphonage in one hour. 

2. Boas' test breakfast, which consists of six 
ounces of strained oatmeal gruel. It is withdrawn 
by siphonage in one hour. 

3. Ewald's test breakfast, which consists of a 
roll and eight ounces of water or weak tea without 
milk or sugar. Siphonage is performed in one hour. 

4. The Leube-Riegel test dinner, which consists 
of soup, meat, and a potato or roll. Siphonage is 
performed in three and a half hours. 



CHAPTER XV 

ADMINISTRATION OF MEDICINES 

Rules for Estimating the Percentage of Solutions. To 
Estimate a Dose of a Different Fractional Part of a Grain 
from the Drug on Hand. To Reckon a Child's Dose 
Apothecaries' Weight. Apothecaries' Measure. The Metric 
System. Symbols and Abbreviations Used in Prescriptions 
and Chemistry. Absorption of Medicines. Different Meth- 
ods of Administering Medicines. Points to be Remembered 
when Measuring Medicines. Food and Drugs. Hypodermics. 
Methods of Giving Medicine by Inhalation, by Inunction, 
by Rectum. Application of Medicine to the Eye. Medicine 
List. Order Book. 

Things a Nurse Should Know about Medicines and 
their Administration 

A NURSE should know the effect of the maximum 
and minimum medicinal doses, the signs of 
over-dosing, and the treatment for poisoning by all 
the drugs in common use. It is very necessary to be 
ever on the watch for signs of over-dosing, as certain 
people have an intolerance for certain drugs, and 
very small doses may bring on untoward symptoms. 
Some drugs have a cumulative action, that is, they 
are not readily excreted from the system, and these 
by accumulating in the body, may cause poisoning if 
the first symptoms of over-dosing are not promptly 
recognised. Even drugs which have not this action 
will, if taken too long, produce undesirable effects, 

190 



Administration of Medicines 191 

the primary symptoms of which must always be 
detected. 

On the other hand, there are drugs to wnich the 
system becomes gradually accustomed, and which, to 
be of any benefit, must be given in increasingly large 
doses. If some of these drugs are continued for a 
long time, the patient may not only become accus- 
tomed to them, but crave them. Indeed, it is thus 
that the cocaine, morphine, and chloral habits are 
often formed. On this account, a nurse should 
make it a rule not to give an anodyne or narcotic 
under ordinary circumstances, without first doing 
all in her power to relieve pain or induce sleep, as 
the case requires (see Chapter VI). 

A nurse should also be familiar with the symbols 
and abbreviations used in writing prescriptions, the 
standard weights and measures (both the apothe- 
caries' and the metric systems), the manner of reckon- 
ing a child's dose, and the rules governing per cent, 
and fractions. The last-named must be employed 
in estimating percentage of solutions and in estimating 
a dose of a different fractional part of a grain from 
the drug on hand. 

To Estimate Percentage of Solutions. — To 
estimate the percentage of solutions, reduce the 
amount of solution to minims, multiply by the rate 
per cent, and point off two places. 

Example: it will take 19.2 grains to make one 
ounce of a 4% solution. 

60 
8 

480 

4 

1920 



19 2 Practical Nursing 



£> 



To Estimate a Dose of a Different Fractional 

Part of a Grain from the Drug on Hand. — You 

are frequently ordered to give a dose of medicine of 

a different fractional part of a grain from the drug 

you have. Thus, you may be told to give gr. -^ 

of strychnine when the only solution on hand is 

mx. =gr. -g 1 ^. To find out how much to give, 

multiply the denominator of the fraction of the 

solution on hand, by the number of minims containing 

it, and divide the result by the amount that you 

wish to give. 

30 
10 

25)300(12 
Give 12 minims. 

To Reckon a Child's Dose. — Medicine is given 
to children in much smaller amounts than to adults, 
the dose varying according to the age of the child. 
To reckon the proper amount, make a fraction, by 
taking the child's age for the numerator and the 
child's age plus 12 for the denominator. This will 
be the fractional part of the adult dose which should 
be given. Thus, a child of eight should be given 
-£$ or J- of the adult dose. 
Apothecaries' Weight. 
20 grains = 1 scruple. 
60 grains = 3 scruples or 1 drachm. 
480 grains = 24 scruples, 8 drachms, or 1 ounce. 
Apothecaries' Measure. 
60 minims = 1 fluid drachm. 

8 fluid drachms = 1 fluid ounce. 
16 fluid ounces =1 pint. 
2 pints = 1 quart. 

4 quarts = 1 gallon. 



Administration of Medicines 193 

The Metric System. — The metric system of 
weights and measures, being more convenient and 
accurate than the apothecaries' system, is now 
gradually being adopted in this country as the stand- 
ard in all scientific w^ork. 

It originated in France in 1790, and has been 
accepted in all European countries, except England 
where, as in this country, it is still optional. 

The metre is the unit of length, the gramme of 
weight, and the litre of volume. The standards 
of capacity and weight are based on the standard of 
length. A gramme is the weight of a cube of water 
at four degrees centigrade, each side of which meas- 
ures one centimetre or one one-hundredth of a metre. 
A litre is the volume of a cube of water at its greatest 
density — four degrees centigrade — each side of which 
measures one decimetre or one-tenth of a metre. 

The prefixes, deca, hecto, kilo, derived from Greek 
numerals, are used to denote increase, and the pre- 
fixes, deci, centi, milli, derived from Latin numerals, 
to denote decrease. 

1000 = 1 kilometre. 
100 = 1 hectometre. 
10 = 1 dekametre. 
1 = 1 metre. 
.1 = 1 decimetre. 
.01 = 1 centimetre 
.001 = 1 millimetre. 
The cube of a centimetre is called a cubic centi- 
metre and is written Lcc. With the exception of the 
centimetre, the numerals denoting decrease are 
rarely used. Thus, instead of saying 1 decimetre, 
we say, 100 c. c. Also, in stating capacity, metre is 
often used instead of litre for the subdivisions. 
—13 



i94 • Practical Nursing 

Thus, we say ioo c.c. instead of i decilitre, and 10 c.c. 
instead of i centilitre. 

Relation between the Apothecaries' and the 
Metric System. — The following table gives the 
approximate relation between the apothecaries' and 
the metric systems. 

i metre = 39.39 inches. 

25 millimetres = 1 inch. 
1 litre = 33.81 fluid ounces or about 2 

pints. 
1 gramme = 1 5 ^ grains. 

.065 " =1 grain. 

29.37 c. c. =1 fluid drachm. 

4 c. c. = 15 minims. 

Symbols and Abbreviations used in Writing 
Prescriptions. — The symbols and abbreviations 
most used in writing prescriptions are the following: 



aa, 


ana, 


of each. 


Abstr. 


abstractum, 


abstract. 


Add., 


adde, 


add. 


Ad lib., 


ad libitum, 


as much as desired. 


Alt. hor., 


alternis horis, 


every other hour. 


Alt. noc, 


alterna nocte, 


every other night. 


Applic, 


applicatur, 


apply. 


Aq., 


aqua, 


water. 


Aq. dest., 


aqua destillata, 


distilled water. 


Aq. pur., 


aqua pura, 


pure water. 


B. i. d., 


bis in dies, 


twice a day. 


c, 


congius, 


a gallon. 


c, 


cum, 


with. 


c.c, 




cubic centimetre. 


Cap., 


capiat, 


let him take. 


Cen., 




centimetre. 


Comp., 


compositum, 


compound. 



Administration of Medicines 195 



Conf., 


confectio, 


a confection. 


Contin., 


continuatur, 


let it be continued. 


Decub., 


decubitus, 


lying down. 


Det., 


detur, 


let it be given. 


Dil., 


dilutus, 


dilute. 


Dim., 


dimedius, 


one half. 


Div. in 


P- 




aeq., 


dividatur in partes 




aequales, 


divide into equal parts 


Emp., 


emplastrum, 


a plaster. 


F., 




Fahrenheit. 


p., 


fac, 


make. 


Fl. or f., 


fluidus, 


fluid. 


Ft., 


fiat, 


let there be made. 


Garg., 


gargarisma, 


a gargle. 


Gr. 


granum or grana 


, a grain, or grains. 


Gtt., 


gutta or guttse 


a drop, or drops. 


Guttat., 


guttatim, 


by drops. 


Inf., 


infusum, 


an infusion. 


Inject. 


injectio, 


an injection. 


Lb., 


libra, 


a pound. 


Liq., 


liquor, 


liquid. 


Lot., 


lotio, 


a lotion. 


M., 


misce, 


mix. 


Mist., 


mistura, 


a mixture. 


N., 


nocte, 


at night. 


No., 


numero, 


in number. 


0., 


octarius, 


a pint. 


01., 


oleum, 


oil. 


01. res., 


oleoresina, 


oleoresin. 


01. oliv., 


oleum olivae, 


olive oil. 


Ov., 


ovum, 


egg- 


Pil., 


pilula, 


a pill. 


P. r. n., 


pro re nata, 


as occasion arises. 



ig6 



Practical Nursing 



Pulv., 


pulvis, 


q. s., 


quantum sufficit 


R., 


recipe, 


Rad., 


radix, 


S. or sig. 


signa, 



Sem. semen, 

S. 0. S., sic opus sit, 

Sp. gr., 

Sp. or spir., spiritus, 



Ss. 

S. V. R., 

S. V. G., 

S. F., 

Syr., 
T. i. d., 
Tr. or tinct., tinctura, 

Troch., trochisci, 

Ung., unguentum, 

M.» minimum, 

3 drachma, 

3 ., uncia, 

3. scrupulum, 



semissis, 

spiritus vini recti 
ficus, 

spiritus vini gal- 

lici, 
spiritus frumenti, 
syrupus, 
ter in die, 



a powder. 

as much as is sufficient, 
take, 
root. 

write i. e., give the 
following directions, 
seed. 

if necessary, 
specific gravity. 
spirit, 
a half. 

alcohol. 

brandy. 

whisky. 

syrup. 

three times' a day. 

tincture. 

lozenges. 

ointment. 

minim. 

drachm. 

an ounce. 

a scruple. 



It is also necessary for a nurse to know the con- 
ventional abbreviations used in chemistry for the 
most common elements. These consist of the initial 
letter of the Latin name of the element, and some- 
times also one of the other letters. When two or 
more elements have the same initial letter, the single 
letter symbol is reserved for the most common 
element. 



Administration of Medicines 197 



TABLE OF COMMON ELEMENTS AND THEIR SYMBOLS 



Aluminum 

Arsenic 

Calcium 

Carbon 

Chlorine 

Gold (Aurum) 

Hydrogen 
Iodine 



Al Iron (Ferrum) Fe Phosphorus 



Lead (Plumbum) Pb Potassium K 

Magnesium Mg Silver | . 

Manganese Mn (Argentum; \ * * 

Mercury (Hydrar- Sodium 



As 
Ca 
C 

CI 

Au 

H 

I Oxygen 



gyrum) 
Nitrogen 



H (X atrium) ) 
N Sulphur 



Xa 
S 



O Tin (Stannum) Sn 



TABLE OF COMMON SUBSTANCES AND THEIR SYMBOLS l 



Acetic Acid ..... 


C 2 H 4 2 


Alcohol ...... 


C 2 H 5 OH 


Alcohol (Wood) .... 


CH3OH 


Ammonium (Gas) .... 


XH 3 


Ammonium Hydrate (Aqua Ammon- 




ium) ..... 


NH4OH 


Aqua Calcis (Lime Water) 


CaOH 


Benzine ..... 


C 8 H ig 


Calcium Carbonate .... 


CaCOj 


Calcium Hypochloride (Chloride of 




Lime) ..... 


CaC10 2 


Carbon Dioxide .... 


co 2 


Carbon Monoxide .... 


CO 


Caustic Soda ..... 


NaOH 


Caustic Potash .... 


KOH 


Cellulose ..... 


C 2 H 10 O 5 


Hydrochloric Acid .... 


HC1 


Potassium Chlorate. 


HC 


Potassium Nitrate, (Saltpetre) 


KXO3 


Potassium Tartrate (Cream of Tartar) 


KC 4 H ; 6 


Sodium Bicarbonate 


XaHC0 3 



J Each letter represents but one atom of the corresponding 
element. When a substance contains more than one atom 
the number of atoms is written after or below the letter. 
Thus H indicates one atom of hydrogen while H 2 indicates 
two atoms of hydrogen and one of oxygen. 



198 



Practical Nursing 



Sodium Carbonate (Washing Soda) 

Sodium Chloride (Common Salt) 

Starch 

Sugar (Cane) . 

" (Grape) 

" (Milk) . 
Tartaric Acid . 
Water . 



Na 2 CO 3 + i H 2 

NaCl 

C 6 H 10 O s 

C i 2 H 2 2^ 1 1 

C 6 H 2 26 

C 1 2 H 2 2O , 1 + H 2 6 

C 4 H 6 6 

H 2 O 



The Absorption of Medicine 

Medicine is introduced into the circulation through 
five channels: the stomach, the rectum, the cellular 
tissue (subcutaneously) , the skin (inunction), and 
the lungs (inhalation). 

The length of time required for the absorption of 
medicine depends upon the solubility of the remedies, 
the method of giving, and the state of the circulation. 

Subcutaneous injections are absorbed, under ordi- 
nary circumstances, in five minutes, as they enter 
directly into the circulation. Owing to the large 
number of blood-vessels in the lungs, medication 
given by inhalation will also be absorbed speedily, 
that is, in five to ten minutes. The average time 
required for gastric absorption depends on the state 
of the stomach and the nature of the medicine. 
Medicine will be absorbed sooner when the stomach 
is empty than when it is full. Solutions are more 
readily taken up into the circulation than powders 
and pills, because the latter must first be dissolved; 
and solutions made with alcohol will probably be 
absorbed in quicker time than those made with 
water or other liquid. Rectal absorption is the 
slowest, requiring three-quarters of an hour. 

The Time to Give Medicine. — The best time to 
give medicine depends on its nature and the effect 



Administration of Medicines 199 

sought. If prompt action is desired, it is given when 
the stomach is empty. The majority of cough 
medicines, cardiac tonics, and diuretics come under 
this head, and are generally given between meals. 
Bitter tonics, being intended to act directly on the 
mucous membrane of the stomach, for the purpose 
of stimulating the secretion of the gastric juices, are 
given shortly before meals. Alkaline tonics are also 
given before meals, except when they are intended 
to neutralise hypersecretion of hydrochloric acid. 
In that case, they are given after eating. Saline 
cathartics and quickly acting purgatives are given 
before meals, preferably before breakfast, but laxa- 
tives are given at night. Acids and other irritating 
substances such as iron, etc., should be given after 
meals and well diluted. Remedies intended to 
effect intestinal, and not gastric digestion, are given 
when the contents of the stomach are about to pass 
into the intestines, viz.: between two and three hours 
after eating. 

Give medicines to be taken before eating, half an 
hour before meal time, and those to be taken after 
eating, twenty minutes after the meal is finished. 

Important Rules for the Giving of Medicine. — 
There are a number of very important rules to be 
observed in the administration of medicine. 

1. While pouring out or administering a dose, 
never think of anything but the work in hand. Never 
speak to any one, nor allow any one to speak to you. 
Otherwise, you will surely make a mistake, and a 
mistake sometimes means the loss of a patient's life. 

2. Always give exactly what is ordered, not one 
drop more nor less. 

3. Give medicines on time. If they are ordered 



2oo Practical Nursing 

for twelve o'clock, for instance, they must have been 
given by that time. 

4. Read the label on the bottle thrice, before 
taking the bottle from the shelf; also, before and 
after pouring out the medicine. 

5. While pouring the medicine, hold the label on 
the upper side, to avoid defacing it, and, before re- 
placing the bottle, wipe its rim with a piece of gauze 
kept for the purpose. 

6. Use graduated glasses and pipettes, not spoons, 
for measuring. 

7. While pouring, hold the glass with the mark of 
the quantity you require on a level with your eye. If 
held above the eye, you will give too little, if below, 
too much. 

8. Give minims when minims are ordered, and 
drops when drops are ordered, for, in many medicines, 
there is a marked difference between the two. 

9. Always shake the bottle before pouring out the 
medicine. 

10. Always re-cork bottles immediately after 
use. Many medicines contain volatile substances 
and will become either stronger or weaker if left 
uncorked. 

11. Never mix, nor give at the same time medi- 
cines which change colour or form a precipitate when 
put together. 

12. Give acids and medicines containing iron 
through a glass tube or straw, as they discolour the 
teeth. 

13. When giving medicine to an unconscious 
patient, drop it far back on the tongue, using a small 
spoon. 

14. Never allow one patient to carry medicine 



Administration of Medicines 20 1 

to another. Innumerable mistakes have thus been 
made. 

15. Some medicines, notably several remedies for 
coughs, should be given undiluted, while others, on 
account of their irritating properties, should be very 
well diluted. Never dilute more than is necessary, 
however, since the addition of a large quantity of 
water renders a disagreeable dose still more un- 
pleasant to take. 

16. Always make a dose as palatable as possible. 
To this end, never use warm water to dilute medicine, 
but either hot or iced water. Holding a piece of 
ice in the mouth for a short time before taking medi- 
cine, or holding the nose while taking it will often 
render a disagreeable flavour less noticeable. Oleum 
ricini (castor-oil), to which lemon juice, a piece of 
ice small enough to swallow, and seltzer have been 
added is not at all unpalatable if it is immediately 
followed by a drink of seltzer. Other oils, with the 
exception of oleum tiglii (croton oil), can be given 
in the same way, or in milk, coffee, brandy, sherry, or 
other wine. Oleum tiglii is given on sugar. Powders 
with a disagreeable taste can be given in capsules or 
cachets. 1 To use cachets, it is necessary to moisten 
their edges to make them stick together, but with 
capsules this is unnecessary, since their two parts 
slip into each other. When the powder is too large 
t<"> be given in this way, it may be put into syrup, 
glycerine, jam, or honey. Powders with a dis- 
agreeable taste are placed far back on the tongue, 
and swallowed with a drink of water, but they should 

1 Capsules or cachets are made of gelatine which melts 
at the body temperature, thus releasing the powder shortly 
after it reaches the stomach. 



202 Practical Nursing 

never be given in this way to an unconscious or a 
delirious patient, as particles of powder might get 
into the larynx. 

17. When you are not certain that pills or tri- 
turates have been freshly made, pulverise them, as 
they 1 soon become so dry and hard that they will 
not readily dissolve in the stomach, and may pass 
through the intestinal tract undigested. 

18. Keep separate medicine glasses for oils and 
strong-smelling drugs. 

Food and Drugs. — The influence of certain foods 
upon certain drugs must be taken into account. 
Starchy foods should be avoided when large doses 
of any iodine composition are being given, as starch 
will neutralise their effect. Milk and acids should 
never be given near together. Milk and albuminoids 
should not be given soon after, nor shortly before doses 
of mercury or calomel, since albuminate of mercury 
will thus be formed, and the medicine will be rendered 
ineffectual. Acids and salts or salty food must not 
be given near to a dose of calomel, for the calomel 
will be changed to corrosive sublimate by their action. 

Hypodermic 2 or Subcutaneous 2 Injections. — 
When prompt action is required, and, sometimes, 
when the stomach is unable to retain medicine 
hypodermic injections are resorted to. The dose 
thus given is usually half to one quarter of that 
given by mouth. 

Drugs intended for hypodermic use are generally 
specially prepared. They are put up in a concen- 

1 This is particularly true of pills. 

'* The word "hypodermic" is derived from two Greek 
words and means "under the skin." Subcutaneous also 
means "under the skin, " but is of Latin derivation. 



Administration of Medicines 20; 



j 



trated form, and great care is taken to have them 
pure and sterile. As a rule, it is only the active 
principle of drugs which is thus given, brandy, 
camphor, and ether being common exceptions. A 
drug not known to be perfectly fresh should never 
be employed hypodermatically, since an abscess may 
result. 

Abscesses may also be caused by an unsterile 
needle or syringe. Therefore, these instruments must 
be carefully sterilised. The syringe is sterilised by 
alternately filling it with alcohol or carbolic 1-20 and 
emptying it. When carbolic is used, the syringe 
must be rinsed with sterile water, before being loaded 
with the drug. If the entire syringe is of glass and 
asbestos, it is often boiled. The needle is sterilised 
by being passed through an alcohol flame, by boiling 
for one minute, 1 by soaking in carbolic 1-20 and 
rinsing in sterile water before use, or by attaching 
the needle to the syringe, holding it in alcohol 95^, 
drawing the alcohol up into the syringe, and then ex- 
pelling the alcohol. This last procedure should be 
repeated five or six times. If the instrument is 
cleansed in the same manner after use, is kept in a 
clean box, and is not used for septic or infectious 
cases, it demands no other treatment. 

A tray, on which all the apparatus needed for sub- 
cutaneous injections is kept, should have a place in 
or near the medicine case. This tray should be 
supplied with three small, 2 covered glass jars (one 
for gauze sponges, another for alcohol, and another 
which should have absorbent or other soft cotton 
in the bottom, for the syringes and needles) and with 

1 Both of these methods soon blunt the needle. 

2 Three inches in diameter. 



204 Practical Nursing 

a small open glass dish in which to put the sponges 
after use. When about to give an injection, carry 
this tray to the bedside, having first filled the hypo- 
dermic at the medicine case and placed it on a sterile 
sponge in such a way that the needle cannot come 
in contact with anything which would render it 
unsterile. The method of filling the hypodermic 
depends on the kind of syringe used. If it is a glass 
syringe, attach the needle, remove the piston, and 
pour in the drug, holding the syringe slightly tilted 
while doing so. Pour in one or two drops more of 
the drug than are necessary, insert the piston, and 
push it gently down. When the piston reaches the 
solution, turn the syringe, pointing the needle upward, 
and gently press the piston until all bubbles of air 
disappear, and only the required amount of medicine 
remains in the syringe. While doing this, hold the 
mark of the required dose on a level with your eye. 
With the majority of metal syringes, the piston cannot 
be removed, and the fluid is drawn up through the 
needle. Otherwise, the method of procedure is 
the same as with the glass syringe. 

Morphine and atropine are sometimes ordered to 
be given at the same time. When this is the case 
pour or draw the first drug in, expel the air, measure 
the second drug in a minim glass which has been 
washed with alcohol, and draw it in, being careful 
not to suck air with it by drawing it in further than 
the needle. 

When doses of less than four minims are ordered 
dilute the drug with an equal amount of sterile distilled 
water, draw it into the syringe, and bring the piston 
to the level of twice the dose ordered. This is done 
because, with the majority of syringes, it is almost 



Administration of Medicines 205 

impossible to measure less than four or five minims 
accurately. Digitalis is often diluted in this way, 
as it is thus rendered less irritating to the tissue. 

The safest places for a hypodermic injection are 
the outer surfaces of the arms, legs, thighs, or 
abdomen. It should never be given over the course 
of a blood-vessel or bony prominence. 

To give a hypodermic injection: Wash the part 
well with alcohol, using a gauzy sponge. Take up 
and hold firmly between the thumb and first finger 
of the left hand a cushion 1 of muscle, stretching the 
skin while doing so. Insert the needle quickly, in 
an almost vertical direction, deep into the tissue. 
Press the piston gently to inject the fluid. Remove 
the needle holding an unused end of the sponge 
against it and press the sponge quickly over the hole 
to prevent the escape of the fluid. Knead the spot 
gently for a few seconds to hasten absorption. 

Before putting away the instrument, clean it in the 
same manner as you prepared it, with the addition of 
drying the needle by inserting and withdrawing a wire 
several times, wiping it before each reinsertion. 
When the needle is dry, leave the wire in it, or it will 
soon become clogged and unfit for use. Never allow 
the point of the needle to come in contact with any- 
thing hard, as it very easily becomes blunted. 

Methods of Giving Medicine by Inhalation. — 
Certain drugs are administered by inhalation, both 
for systemic and local effects. 

Ammonia, the anaesthetics — ether, chloroform, etc., 
— creosote and eucalyptus are given by sprinkling on 
a towel, cloth, or cone — made for the purpose, — which 

1 Note that it is the muscle, not the mere skin that is to 
be grasped. 



206 Practical Nursinp" 

o 

is held over the nostrils and mouth. Before giving 
chloroform, always rub vaseline or oil on the patient's 
face, or an intense irritation may ensue. 

Dry Inhalation. — To give a dry stramonium 
inhalation, put stramonium leaves into a bowl, 
fasten a cone of stiff paper over the bowl, set fire to the 
leaves, and have the patient inhale the smoke through 
the free end of the cone. 

Oxygen may be given by dry inhalation. It is 
employed when, from any reason, the lungs are 
failing to take a sufficient amount from the air. 
Cyanosis is an indication that this is happening. 
The amount of oxygen being used may be estimated 
and, therefore, regulated, by making it pass through 
water, the quantity passing being indicated by the 
size of the bubbles produced. Enough oxygen to 
produce small bubbles suffices. The method of 
giving oxygen is as follows: Stand an oxygen tank 
on the floor by the bedside. Connect its faucet, by 
means of rubber tubing with an "oxygen bottle" 
half filled with water. 1 Any bottle with a wide mouth 
and full rounded bottom will answer the purpose. 
Insert in the bottle a cork, preferably a rubber one, 
making two holes in it for the introduction of glass 
tubes. These tubes must be bent, and one should be 
longer than the other. Attach the tubing connected 
with the tank, to the longer one, and a second piece 
of rubber tubing long enough to reach the patient's 
mouth, to the shorter one. Fit a funnel into the other 

1 Certain drugs such as creosote, carbolic etc., are some- 
times ordered to be added to the water. It is essential to 
remember the right connection of the tubes, since a mistake 
will lead to the cork and water being blown out of the bottle 
as soon as the oxygen is turned on. 




CQ 



Administration of Medicines 207 

end of this tubing. Hold the funnel either at the 
side of the face, slightly tilted forward, or at least 
twelve inches above the mouth. Never hold it 
directly over the mouth, or the exhaled breath will 
be thrown back, and the effect of the oxygen will be 
minimised. 

Steam Inhalations. — Steam inhalations may be 
given in a number of ways: 

1. Pour the drug prescribed into a "Maw's in- 
haler, " a carafe, or a pitcher of boiling water. AVrap 
the receptacle in a bath towel or small blanket, 
leaving a small opening, if the carafe or pitcher is 
used, through which the vapour can be inhaled. The 
"Maw's inhaler" is fitted with a mouthpiece and, if 
this is used, only the mouthpiece is left uncovered. 

2. If the inhalation is to be continued for some 
time, put the medicated water into a kettle, and keep 
it boiling over a gas or alcohol lamp. Attach either 
the small end of a cone made of stiff paper or a piece of 
rubber tubing to the spout of the kettle, and insert 
a funnel in the free end of the tubing. This will 
make it easier for the patient to get the full benefit 
of the steam. 

3. A croup tent, so-called because of its frequent 
use in croup, may be used in giving steam inhalations. 
To make such a tent: Stretch two sheets, right sides 
together. If the steam is to be introduced at the back 
of the bed, pin them down the centre, putting the pins 
quite near each other, and fold each sheet over upon 
itself in order to form a seam. If the steam is to be 
introduced at the side, put the sheets wrong sides 
together, and do not pin. Some hospitals have 
hoops which fit into the tops of the beds, and others, 
various forms of frames which can be tied to the 



208 Practical Nursing 

bed and over which the sheets can be draped (see 
illustration) . Lacking these, tie sticks or rods, 1 four to 
five feet in length, to each corner of the bed, tie a 
bandage from rod to rod, stretching it tightly, and 
drape the sheets over this bandage. To drape the 
sheets: Wind a bandage around the hoops or the top 
of the frame. Secure this in place. Put the doubled 
sheet over it, allowing it to hang about a foot in 
front, and at least to the line of the mattress in the 
back. Fold the excess width from the back around 
the sides, and pin to the bandage. Then, fold up the 
sides of the front, and pin them in place (as in the 
engraving). If the steam is to be introduced at the 
back, put the spout of the kettle through an aperture 
which can be made by removing a pin or two in the 
seam. The spout of the kettle must be at least two 
feet above the patient. 

In an emergency, an umbrella can be tied to the 
head of the bed and a sheet thrown over it in such a 
manner that the sides and back of the bed will bewailed 
in, and the steam can be made to enter at the back. 

Inunction. — Medication is sometimes given by 
absorption through the skin (inunction). The pro- 
cess is described in Chapter X, under the head of 
"Local Applications." 

Methods of Giving Medication by Rectum. — 
The two methods of giving medication by rectum are 
enemata and suppositories. The dose of medicine 
given by rectum is usually twice as large as that 
given by mouth, absorption in the large intestine 
being incomplete. 

Enemata. — The giving of enemata is described 
in Chapter XIII. 

1 Umbrellas or canes will answer the purpose in the home. 



Administration of Medicines 209 

Suppositories. — Suppositories are conical-shaped 
preparations of cocoa-butter, in which various drugs 
are incorporated. Though solid enough to retain 
their shape in the usual room temperature, the cocoa 
butter melts readily after it is introduced into the 
rectum, releasing the drug, which is then absorbed. 
To insert the suppository, oil both it and the index 
finger, and hold a folded towel to the anus till all 
desire to expel the suppository has passed. 

Application of Medicine to the Eye. — To apply 
medicine to the eye, separate the lids with the thumb 
and first finger of the left hand, making pressure on 
the frontal and malar bones, and have the patient 
look up. When this is properly done, there is quite 
a trough between the eyeball and the lower lid, and 
it is into this that the application should be poured. 
If the application is intended for the cleansing of the 
eye, direct its current from the inner to the outer 
angle. Otherwise, the discharge may be washed into 
the lachrymal sac and a serious inflammation result. 
For this same reason, wipe from the inner to the outer 
angle of the eye when wiping out a discharge. On 
the other hand, when dropping into the eye medica- 
tion intended to remain there, drop at the outer 
angle, since, if it is put in near the opening of the 
lachrymal sac, it will flow into the sac immediately 
and the eye will not be benefited. An ordinary 
medicine dropper can be used for any of these pur- 
poses, but for the cleansing application a soft rubber 
eye syringe or compress of absorbent cotton is better. 

Whatever the implement used never let it touch 
the eye. 

When the medication is intended for the lids, 
evert the lids well and drop the medication directly on 
14 



210 Practical Nursing 

them. To evert the lower lid, place the thumb near 
its margin and press it downward, while the patient 
looks upward. To evert the upper lid, hold the 
lashes between the thumb and index finger of the 
right hand, draw the lid down, place a probe, thin 
pencil, toothpick or similar implement horizontally 
across it, and turn the lid back over the implement. 
Medicines which dilate the pupil . are called 
mydriatics, those which contract it myotics. 

Medicine Lists 

There are a variety of methods in hospitals, for 
keeping lists of medication, to insure its correct 
administration. 

One of the best methods, which was devised in 
St. Luke's Hospital, New York, some years ago, con- 
sists of having tickets, two inches square, of coloured 
cardboard, a different colour or shape being employed 
for each time of administration. Thus: red signifies 
every four hours; red, with a corner off, every two 
hours; pink, every three hours; yellow, after meals; 
blue, before meals; white, every night; white, with a 
corner off, every morning, etc. On these tickets, are 
written the patient's name, the name and dose of 
the medicine, and the hour of giving. They are kept 
in the medicine case, each colour and shape together. 
As soon as the medicine is poured out, the ticket is 
placed on the medicine glass and must not be taken 
off, until the medicine is given to the patient. When 
giving out a number of medicines at the same time, 
read each ticket before taking it off the glass. New 
tickets are made out and old ones destroyed as soon 
as medication is ordered or changed, a check being 
made in the Doctor's Order Book to show that this 



Administration of Medicines 2 1 1 

has been done. The tickets to be destroyed are 
doubled and left on the head nurse's table. They 
must not be thrown away, and new tickets must not 
be put into the medicine case until the nurse in charge 
of the ward has compared them with the order book. 

Another method of administering medicine is to 
have the medicine tray marked in numbered squares. 
The beds in the wards are distinguished by corre- 
sponding numbers, and the medicine for each patient 
is placed in the square bearing the number of his 
bed. Lists of the medication, on which are in- 
scribed the number of the bed, the patient's name, 
the name and dose of medicine, and the hour of giving 
are also kept. 

A record of all medication given should be made 
on the patient's chart, as well as on the medicine list, 
and the result of the medicine should be watched 
for, and charted. 

The Doctor's Order Book 

It is a wise rule of many hospitals, that a " Doctor's 
Order Book" be kept in every ward, and that, except 
in emergency, no medicine be given, the order for 
which has not been first written in this book by- the 
doctor. In these hospitals a nurse is sometimes 
allowed to write the orders, but, in that case, the 
doctor must read them and sign his name to them. 

The Medicine Case 

The ideal medicine case is of glass, with a painted 
iron or nickel frame. Provided that the case is 
always locked, and the key never left near it, there 
will be less danger that the patients will help them- 
selves to its contents if it is kept in the ward, than 



212 Practical Nursing 

in an adjoining room. But whatever the style of 
the medicine case, it should be always scrupulously 
clean and neat. One great secret of keeping it so 
is to wipe the rims of the bottles carefully, before 
replacing them after use. 

Bon Ami, or ordinary whiting is better than either 
soap or ammonia for cleansing glass, paint, and 
nickel. When washing the shelves of the case, never 
take down more bottles than can be quickly replaced 
if you are obliged to leave your work. Medicines 
must never be left out of the case, nor the case left 
unlocked. 

So far as possible, keep the medicines in alpha- 
betical order, but with bottles of the same size to- 
gether. All the more powerful drugs should be kept 
in bottles with rough exteriors and of a different 
size from the others. They should be marked " poi- 
son" and placed together. Never have medicine 
in unlabelled bottles, nor leave a dose of medicine in 
an unmarked glass. Never order a large amount 
of medicine at one time. There are few medicines 
that will not deteriorate with age. 

There should be two trays in or near the medicine 
case. On one, keep the medicine glasses, minim 
glasses, medicine dropper, water pitcher, glass rod — 
for stirring mixtures — drinking tubes, a towel to 
use when washing the glasses. The other tray is 
required to carry the medication to the patients. 



CHAPTER XVI 



EMERGENCIES 



Surgical Emergenices : Burns and Scalds; Contusions; 
Dislocations; Foreign Bodies in Ears, Eyes, Nose, Trachea, 
and Tissues; Fractures; Haemorrhage; Shock; Sprains; 
Wounds. Medical Emergencies: Apoplexy; Asphyxia (Arti- 
ficial Respiration) ; Collapse ; Convulsions ; Drowning ; Epi- 
lepsy; Fainting; Hysteria; Intoxication; Poison; Sunstroke. 



OUTSIDE the hospital, a nurse will often be 
obliged in emergencies to take the entire re- 
sponsibility of a case, though she must remember 
that, except in very simple accidents, she is to do 
only that which is absolutely essential, and must get 
a doctor as soon as possible. In the hospital (barring 
extreme cases, such as haemorrhage) there is not 
much for the nurse to do in emergencies except to 
notify the doctor, get everything that he will re- 
quire ready, and give him prompt and intelligent as- 
sistance in his work. Nevertheless, in the hospital, 
as well as outside of it, she must act quickly and keep 
cool. 

Emergencies may be divided into two classes, 
surgical and medical. 

213 



214 Practical Nursing 

Surgical Emergencies 

Burns and Scalds. — A scald is an injury to the 
tissues caused by moist heat, while a burn is a like 
injury produced by dry heat. The treatment in 
both cases is practically the same. 

Burns are classified according to the depth of the 
injury, as being of three degrees: First, redness of the 
skin; second, vesication; third, charring of the skin 
and deeper tissues. 

Burns of the third degree will of course do serious 
damage to the tissue and function of the affected 
part; but, so far as the danger resulting from shock 
and systemic after-effects are concerned, it is not 
the degree of the burn, but the extent of the skin 
surface destroyed, that is of importance. 

Shock is always to be expected, and treatment 
must be applied after a burn of any extent. It must 
be remembered that the patient need not necessarily 
be unconscious or in a state of coma to be suffering 
from shock. Patients who have never been uncon- 
scious have died from heart failure, resulting from 
shock. 

Other causes of death following burns are: pneu- 
monia, resulting from the irritation of the bronchi 
and lungs, due to the inhaled smoke; haemorrhage, 
from the sloughing of the blood-vessels; sepsis, from 
the absorption of the purulent discharges; and in- 
flammation of the internal organs, from the ab- 
sorption of septic material and, in the case of the 
kidneys and intestines, of the extra work thrown 
upon them by the failure of the skin to perform its 
part in the elimination of waste matter from the body. 
Death from the last two causes may not take place 
for several weeks, but a fatal issue is likely to follow 



Emergencies 215 

burns, if more than one-third of the body is involved, 
and will almost certainly occur, if two-thirds of the 
skin surface has been destroyed. 

Burns are produced by the action of fire, strong 
acids, and alkalies. 

Fire. — If your own clothes should catch fire, lie 
down on the floor and press the burning portion to 
the ground. Keep your mouth shut, to avoid the 
inhalation of smoke. If another person is the sufferer, 
wrap him quickly and tightly from head to foot in a 
blanket, rug, or other heavy woollen article, beginning 
at the head, and roll him on the floor. Before re- 
moving the blanket, be sure that the flames have 
been smothered. 

Treatment. — Shock is the first thing to be con- 
sidered in the treatment of burns. Loosen all clothing, 
keep the patient quiet and in the recumbent position, 
apply heat, give plenty of fresh air, and, if the pulse 
is weak, stimulation. Whisky is the stimulant to 
be preferred when necessary to give one without a 
doctor's order. Formerly the air was always imme- 
diately excluded from the wounds by means of a 
dressing. Gauze, clean, soft linen or cotton, wet 
in a saturated solution of bicarbonate of soda or 
carron oil 1 is the dressing most frequently used. 
The bicarbonate of soda has the advantage of being 
odourless and cleanly, and is generally easily ob- 
tained. Its use is continued for only two or three 
days and is followed by a dressing of sterile boric 
acid, zinc oxide, or other ointment (see Chapter XV). 
In many hospitals the ''open treatment" is now 
used; the patient is kept in a warm room and the 
wounds dusted with stearate of zinc and exposed to 

1 Carron oil is a mixture of equal parts of olive oil and lime 
water. 



216 Practical Nursing 

the air. In caring for severe burns, the danger of 
deformity, caused by the contraction of the skin and 
underlying muscles must be remembered, and any 
suspicion of this condition reported. This danger 
can be somewhat obviated if treatment by the appli- 
cation of splints, or Buck's extension is started in 
time, and massage, begun at an early date, is in- 
valuable. Burns are sometimes treated with con- 
tinuous warm baths (see Chapter IX). 

Acids and Alkalies. — Burns produced by an acid 
other than carbolic acid, are best dressed in the 
beginning with dry bicarbonate of soda. For car- 
bolic acid burns, use alcohol. When burns are 
caused by an alkali, neutralise the effect by washing 
with diluted vinegar or lemon juice, and afterwards 
apply an ointment dressing. 

For burns of the eye resulting from the introduction 
of strong alkalies, irrigate freely with warm water 
or boric acid solution. For acids, apply a few drops 
of pure albolene or white vaseline. 

Contusions. — Contusions are injuries in which 
extravasation of blood into the cellular tissue takes 
place, due to the rupture of the superficial capillaries. 
The result is oedema and discolouration of the skin. 

Treatment. — The objects aimed at in the treatment 
of contusions are: The prevention of the further 
escape of blood into the tissues; the counteracting 
of any tendency to inflammation; the relieving of 
pain, and, in cases where the tissue is crushed, the 
restoration of vitality of the part. Either very cold 
or very hot applications are, therefore, the general 
remedy, the former being usually preferred in slight 
contusions, and the latter, when the vitality of the 
tissue has to be considered. 



Emergencies 217 



Dislocations. — A dislocation is the displacement 
of any of the articular bones. It is associated with 
more or less injury of the ligaments. Its symptoms 
are: loss of function, deformity, and pain. 

Treatment. — An improperly reduced dislocation 
will result in permanent deformity. Therefore, if 
any of the large joints are affected, a nurse should 
not do more than apply cold to keep down the swelling, 
and see that the extremity is properly supported, till 
a surgeon's services can be obtained. Dislocation 
of the fingers can sometimes be easily reduced by 
pulling them gently. A dislocated jaw can also, at 
times, be easily brought into place in the following 
manner: Protect the thumbs well, and place them 
on the back teeth, at the same time holding the 
fingers under the jaw. Forcibly depress the angle, 
of the jaw, lifting the chin at the same time, and 
remove your thumb quickly, for the jaw will slip into 
place with a snap. 

Foreign Bodies in the Ears, Nose, Trachea, 
and Tissues. — Never poke at anything in the ear. 
If there is an insect in the ear, lay the patient down 
on the side opposite to the affected ear, pull the tip 
of the ear upward and backward, and syringe gently 
with warm water. Be careful not to close the orifice 
with the end of the syringe. For hard substances, 
except such as will swell with moisture, syringe the 
ear with warm water. If the substance cannot be 
removed by syringing, medical aid had better be 
sought. 

To remove lime or other soluble substance from the 
eye, bathe the eye with warm water. Insoluble sub- 
stances, such as dust or cinders, can often be re- 
moved by drawing the upper lid down over the eye, 



218 Practical Nursing 

and blowing the nose forcibly at the same time. If 
the particle is caught under the upper lid, instruct 
the patient to look down, turn the lid back over a 
small pencil or knitting needle, being careful not to 
make pressure on the eyeball, and then, with the 
corner of a handkerchief, wipe off the offending 
object. If the particle is under the lower lid, draw 
the lid down against the cheek-bone and instruct the 
patient to look up. If it seems to be imbedded in the 
eyeball, do not interfere with it, but have the eye 
seen by an oculist at once, or permanent injury may 
result. 

When any foreign substance gets into the nostril 
have the patient take a deep breath, close the mouth, 
and press the other nostril. The air is forced out, 
and the object may then dislodge. If it does not, 
make compression on the nostril above the object, 
and try to draw it out with a hair-pin or bent 
wire. 

An obstruction in the throat, trachea, or oesophagus 
may sometimes be removed by striking the patient 
forcibly on the back, between the shoulders. Some- 
times it is expedient to invert him while doing so. 
A child can be held up by the legs ; but an adult should 
be placed across a bed, couch, or chair, with his head 
and chest hanging well over the edge. If the object 
is in the oesophagus, it can often be washed down 
by a drink of water, or forced down by eating bread 
or other solid substance. To prevent excoriation 
of the alimentary canal, after the swallowing of any 
sharp substance, have the patient eat plentifully 
of bread, potatoes, or mush, but do not give a 
purgative. 

To extract a barbed instrument, such as a fish- 



Emergencies 219 

hook, from the flesh, push it sufficiently through to 
break off the head before drawing it back. 

Fractures. — A fracture is a dissolution of con- 
tinuity of the osseous tissue. The symptoms are: 
loss of function, abnormal mobility, crepitus, pain, 
swelling, and discolouration, the last-named being 
due to extravasation of blood and serum at the point 
of fracture. 1 

A fracture may be simple, compound, complicated, 
comminuted, impacted, multiple, or greenstick. 

In a simple fracture, the bone is severed, but there 
is no wound in the tissue at the seat of fracture, ex- 
posing it to the outer air. A compound fracture is 
one in which the air communicates with the ends 
of the broken bone. A fracture is said to be com- 
plicated, when wounds are present, but not at the 
seat of fracture, and when a joint is involved. In 
an impacted fracture, the broken ends of the bone 
have been forcibly driven into and fixed against 
each other. In a comminuted fracture, the bone is 
broken, or crushed, into many pieces, and the breaks 
communicate. A multiple fracture differs from a 
comminuted fracture in that, though there are many 
breaks, they do not communicate with each other. 
A greenstick fracture is an incomplete fracture. 
It occurs most frequently in children, because, owing 
to the gelatinous nature of their bones, the bone is 
not easily completely severed. 

Fracture of the lower end of the fibula, complicated 
with dislocation of the ankle joint and fracture of 
the inner malleolus, is called Pott's fracture. Frac- 

1 Scudder, in his Treatment of Fractures, uses the .more 
definite terms " closed " and " open " wounds instead of those 
so long in use " simple " and " compound." 



220 Practical Nursing 

ture of the lower end of the radius is known as Colles's 
fracture. 

According to the direction of the break, fractures 
are said to be longitudinal, oblique, or transverse. 

Treatment. — It is a mistake to imagine that a 
fracture must be reduced immediately. Far more 
harm is done by unskilful setting than by allowing 
the patient to wait some hours, or even two or three 
days, until the swelling has disappeared and proper 
aid can be secured. In the meantime, handle the 
fracture as little as possible and apply temporary 
splints to keep the broken bones in apposition and 
to prevent pain from the spasmodic twitching of the 
muscles. These splints can be made by binding 
pieces of board, shingles, strong pasteboard, a pillow, 
a couple of umbrellas or walking canes, on either side 
of the extremity. 

Apply cold, such as ice-caps, or compresses wrung 
out in an iced solution, such as lead and opium, to 
control the swelling, which, if it becomes severe, will 
make the fracture harder to reduce. 

In a case of fractured thigh, extend the leg and 
bind to it a splint long enough to reach from the 
axilla to the heel. When the fracture is of the leg, 
the splint need only extend from the heel to above 
the knee. When the patella is fractured the leg 
should be elevated and the bones kept in apposition 
by the application of a long splint at its back. For 
a fracture of the forearm, bind a well-padded splint 
on each side of the arm, keeping the thumb up and 
leaving the fingers above the knuckles free, and place 
the arm in a sling (see Chapter XVII) . For a fractured 
clavicle, have the patient lie on his back, without a 
pillow, and bind the arm on the injured side across 



Emergencies 221 



his chest. For fractured ribs, keep the patient quiet, 
pin a broad binder tightly across his chest, and watch 
for any bloody expectoration — puncture of the lung 
by the broken bone being a common complication. 
For a fractured pelvis or spine, keep the patient on 
his back, and very quiet, and put a fracture-board 
under the mattress. 

For a fracture of the skull: Keep the patient quiet 
and the head of the bed slightly elevated. Watch 
for twitching, convulsions, or paralysis of any part of 
the body, and report any such symptoms immediately, 
as they denote pressure upon some part of the brain. 
Blood oozing from the ears, mouth, or nose, or ecchy- 
mosis around the eyes usually means that the fracture 
is at the base of the skull — a very serious condition. 
Keep the blood washed away, as it is a good culture 
media for germs. Apply ice-caps to the head. 

Great care must be taken in handling fractures. 
A simple fracture may be made compound by careless 
handling. When lifting, apply support under the 
point of fracture, and under the joints both above 
and below it. The wound in a compound fracture 
must be carefully cleansed and dressed with the 
usual antiseptic precautions. 

The repair or knitting of a bone is due to a sub- 
stance known as callus, which nature, soon after the 
occurrence of the accident, throws out around the 
ends of the broken part. This callus is soft at first, 
but gradually hardens and glues the bones together. 
The callus which forms around the outer edges of the 
bones is called provisional callus, and this is in time 
reabsorbed, being only intended by nature to aid in 
keeping the bones in apposition. The bone should 
be fairly strong at the end of six weeks, but it will 



222 Practical Nursing 

take from six months to a year for the affected part 
to be as firm as it was before the accident. 

Hemorrhage. — Haemorrhage is the escape of 
blood from its containing vessels. When caused 
by a wound, it is called traumatic, but when it is 
due to a diseased condition of the blood-vessels, it 
is said to be spontaneous. According to the vessel, 
from which the blood escapes, the haemorrhage is 
known as arterial, venous, or capillary. The variety 
will be recognised by the manner in which the blood 
comes from the wound. In arterial haemorrhage it 
will, owing to the contractive power of the arteries 
be thrown out in jets or spurts corresponding to the 
heart-beats, and will be a bright red colour. In 
venous haemorrhage, it will be darker in colour and 
will flow from the wound in a steady stream. In 
capillary haemorrhage the blood will ooze from the gen- 
eral surface of the wound, and not from anyone point. 

Haemorrhage occurring immediately after a wound 
or operation is known as primary, while that which 
comes on some hours or days afterwards is known 
as secondary. Secondary haemorrhage is generally 
caused either by the slipping of a ligature or by the 
sloughing of the tissues and blood-vessels. 

In cases of internal haemorrhage, the escaping blood 
does not always come away immediately, and con- 
stitutional symptoms only will indicate that a 
haemorrhage is taking place. The symptoms are: 
a growing pallor; weak, shallow, sighing respiration ; 
thirst; restlessness; a longing for fresh air; vertigo; 
a weakening of the pulse beats which also become 
rapid and irregular; a falling temperature. 

When the haemorrhage is from one of the larger 
arteries, death may ensue in less than five minutes. 



Emergencies 223 

Treatment. — The first two things to consider in 
endeavouring to control a haemorrhage are position 
and pressure. 

Position. — When the haemorrhage is from an ex- 
tremity, elevate or flex the limb; when from the 
head, elevate the head of the bed; when from the 
abdomen, elevate the foot of the bed. 

Pressure. — Pressure may be direct or indirect, 
and provisional or permanent. 

Direct pressure is made directly over the bleeding 
point. This is done by bandaging tightly rolled com- 
presses of gauze firmly over the wound, or, if the 
wound is deep, by packing it tightly with gauze 
before applying the compresses. This method, if 
the haemorrhage is from the larger arteries or veins, 
might not be sufficient; or it might be inadvisable 
to use it either because of the nature of the wound, 
or the danger of infection. In these contingencies 
indirect provisional pressure must be made. 

Indirect pressure is made over the large artery or 
vein which supplies the part. Pressure for arterial 
haemorrhage must be made between the heart and 
the bleeding point; for venous it is first made be- 
tween the periphery and the wound, and then above 
the wound to prevent the engorgement of the veins, 
or the entrance of air into them. This mode of 
pressure is called provisional, because it must not 
be continued for any length of time or gangrene will 
result. It can be safely continued for only one hour. 
It is made either by pressing the thumb or the 
fingers directly over the course of the artery or by 
applying a tourniquet or Esmark bandage. 

A tourniquet can be made of a handkerchief or a 
bandage of any kind. To prepare and use a tourni- 



224 Practical Nursing 

quet: Place some hard substance in the centre of the 
bandage or make a large firm knot in it, and put this 
over the course of the artery. Tie the bandage 
tightly. Introduce a stick, pair of scissors, or any 
similar object under the bandage, then turn, twisting 
the bandage until the bleeding ceases. When possible 
put a piece of cardboard or like substance under the 
bandage at this point, to avoid catching in the skin 
while twisting the bandage. 

The Esmark bandage is made of rubber. In 
applying it, make a few spiral turns around the 
extremity, pulling the bandage to its full extent. 
Leave a portion of the bandage rolled and slip the 
roll in under the last turn of the bandage, placing 
the roll over the artery. An ordinary piece of rubber- 
tubing applied tightly and tied in a surgeon's knot will 
form an effective substitute. 

To be able to make pressure without loss of time 
it is necessary to know the course of all the large 
arteries. Nurses should therefore give this study care- 
ful attention and should practise stopping the arter- 
ies on each other. To do this make pressure on the 
large arteries which supply the extremities with blood 
and then feel at the points below where the pulse can 
usually be felt ; if there is no pulsation in these arteries 
the pressure is effectual. 

To control haemorrhage of the scalp by indirect 
pressure, make the pressure on the temporal arteries; 
of the face, on the facial arteries either at the lower 
jaw just below the angle of the mouth or before the 
ears above the angle of the jaw. For haemorrhage 
of the axilla or of the shoulder make pressure on the 
subclavian artery by pressing the fingers in behind 
the clavicle near its centre. For haemorrhage of the 



Emergencies 225 

arm or hand make pressure on the brachial artery ; this 
can be best reached between the biceps and triceps 
muscles, or the inner surface of the arm, at the end 
of the upper third of the length from the shoulder 
to the elbow. Haemorrhage, on the hand, can also 
be controlled at the wrist ; pressure there must be 
applied on both the radial and ulnar arteries. Haemor- 
rhage of the thigh can be arrested by pressure on the 
femoral artery, either where it passes over the rim 
of the pelvis — viz. : at about two-thirds of the dis- 
tance from the hip bone to the middle line of the 
body — or at Scarpa's triangle. For bleeding of the 
leg below the knee pressure is made on the popliteal 
artery, behind the knee, and on the anterior and 
posterior tibial arteries for haemorrhage in the foot. 

After the amputation of a leg, as there is even more 
than the average danger of haemorrhage, either an 
Esmark bandage or tubing should be kept near the 
patient's bedside for at least ten days. 

Other Methods of Arresting Hemorrhage. — Other 
methods of arresting haemorrhage are: 

1. The application of heat and cold. Heat 
coagulates the albumin of the blood and thus favours 
the formation of clots, it also contracts the arteries. 
Examples of its use are : the hot douche (i 20 to 1 24°F.) 
in uterine haemorrhage, hot irrigations and the use 
of the actual cautery during operations. Cold con- 
tracts the arteries but interferes with the clotting of 
the blood. It is generally applied in the shape of 
ice or ice-water, either in ice-caps, ice-poultices, or 
ice-coils. 

2. The use of astringents, such as acetic acid, 
adrenalin, and ergot. The acetic acid is added to 
hot douches, the ergot is given internally, and the 

15 



226 Practical Nursing 

adrenalin is employed both internally and externally. 

3. The use of styptics, such as alum, gallic acid, 
and lunar caustic. Styptics are rarely employed 
now, because, although they are often efficacious in 
arresting haemor hage, their action is deleterious to 
the tissue. Iron is sometimes used to arrest bleeding 
after extracting teeth and slight operations such as 
tonsillotomy. 

4. Ligation. The bleeding vessel is held by a 
pair of forceps while a ligature is tied around it. 

5. Torsion. The artery is seized by the forceps 
and twisted. The twisting renders the use of a 
ligature unnecessary. 

To check epistaxis (nose-bleed), elevate the arms 
and head, and apply cold to the back of the neck, 
forehead, and bridge of the nose. It is also useful to 
make pressure against the base of the nostrils by 
placing two fingers beneath the upper lip and pressing 
upward. When these methods fail, astringent sprays, 
such as adrenalin 10,000, can be used, or the anterior 
nares can be plugged by packing them tightly with 
absorbent gauze. Formerly, in cases of severe 
epistaxis, the posterior nares were plugged by at- 
taching a tampon by a string to a rubber catheter, 
inserting the catheter in the nostril, passing it through 
the mouth and drawing it out, thus pulling the tam- 
pon into place. This is very rarely done now, the 
simpler method being usually quite as effectual, as the 
majority of haemorrhages take place from the anterior 
nares. 

In cases of internal haemorrhage (as from the 
lungs, intestines, etc.), keep the patient quiet in a 
recumbent position, and, if the haemorrhage is severe, 
shut off the return circulation from the extremities 



Emergencies 227 

by the application of tight bandages. In applying 
these bandages, begin at the shoulders and the thighs. 
By thus giving the heart less fluid to pump, its con- 
tractions are weakened and the blood, being sent 
with less force to the bleeding point, has a chance 
to clot at the ends of the vessels. One limb is always 
left unbandaged, the bandages being changed altern- 
ately, so that the circulation is not shut off from any 
one extremity longer than three-quarters of an hour. 

After the haemorrhage has been controlled the 
bandages are often applied in the opposite manner, 
that is, the extremities are raised and the bandages 
applied beginning at the periphery. This is done in 
this manner to keep the blood from the legs and arms 
and thus give the heart a larger supply. 

The vomiting of blood is called haematemesis. The 
blood may come from all parts of the alimentary 
canal, or from the respiratory organs. When it 
comes from the stomach, it is dark coloured, and 
sometimes has a coffee-ground appearance. Haem- 
orrhage from the stomach is generally due to either 
ulcer or carcinoma of the stomach. In addition to 
the treatment already described, the patient must 
not be given food till ordered by the doctor. Crushed 
ice is often given. 

Haemorrhage from the lungs is called haemoptysis. 
It is easily recognised, as the blood is frothy by 
reason of the admixture of air. 

Blood in the urine is called haematuria. The blood 
may come from the kidneys, bladder, or urethra. 
When it comes from the kidneys, it is dark and 
clotted; when from the bladder, it is generally 
clearer. 

Haemorrhage from the intestines is known as 



228 Practical Nursing 

enterorrhagia. As in haematemesis, food must be 
discontinued until ordered by the doctor. 

In cases of uterine haemorrhage, hot douches 
(i2o°-i24°F.) are generally given, acetic acid being 
frequently added to the douche. Ergot is also 
generally given, either through the mouth or hypo- 
dermatically, for its contractive effect upon the 
arteries. It is often necessary to pack the uterus. 
This is done by inserting either long strips of gauze, 
leaving the ends free, or tampons. The packing 
must be very tight, or it will be worse than useless. 
Only in an extreme emergency, when other means 
had failed, w T ould a nurse be justified in doing this. 
Everything used must be sterile. 

Haemorrhage following child-birth is called post- 
partum haemorrhage. 

Haemorrhage from the umbilicus in new-born in- 
fants is generally best controlled by the use of styptics. 
Alum and powdered perchloride or iron are most 
frequently used. 

Haemophilia (hereditary haemorrhagic diathesis) is 
a hereditary predisposition to haemorrhage, trans- 
mitted along the female line of descent. It is due 
both to the incapacity of the blood to coagulate 
properly, and to thinness of the walls of the blood- 
vessels. In persons thus afflicted the slightest 
wound may result fatally. 

Shock. — All accidents of any severity are likely 
to be followed by shock, and it is often necessary to 
treat patients for this before even carrying out the 
specific treatment. Shock is a partial or complete 
prostration of the vital forces. Its symptoms are: 
a weak and irregular pulse, irregular, sighing respira- 
tion, mental and muscular weakness, pallor, and a 



Emergencies 229 

cold exterior. The temperature is subnormal at 
first, but pyrexia is apt to follow. The patient may 
or may not be unconscious. Complete uncon- 
sciousness is an unfavourable symptom. Vomiting, 
on the other hand, is a favourable one, since it shows 
that the nerve centres are not completely prostrated. 

Treatment. — To treat shock, loosen all clothing, 
elevate the foot of the bed, apply heat and give plenty 
of fresh air. Stimulation is given if there is no haemor- 
rhage. If there is haemorrhage this must be checked 
first, and stimulation given, if at all, with caution. 
It must never be forgotten that the symptoms of 
shock are not always obvious immediately after an 
accident. The excitement caused by the event often 
acts as a strong stimulant for the time being. There- 
fore, after any severe accident keep the patient 
quiet and warm, or a sudden collapse may 
follow. 

Sprains. — A sprain is a wrenching or twisting of 
a joint, accompanied by a stretching of the ligaments 
and tendons. A sprained limb should be elevated 
and supported, and treated with either very cold or 
very hot applications. The two are sometimes alter- 
nated. In this case, the injured member is first treated 
either with a bath of hot water or applications of hot 
cloths and then with iced compresses or an ice-cap. 
Light massage is given after a few hours. The limb 
should be firmly strapped or bandaged, and should be 
permitted moderate use, unless there is some further 
complication. A nurse, being unable to differentiate 
between a sprain, dislocation, or break, should do 
nothing further than employ the hot and cold treat- 
ment until the patient has been seen by a doctor. 

Wounds. — Wounds have been described as " breaks 



230 Practical Nursing 

in the continuity of the soft tissues." According to 
their nature, they are known as: 

1. Contused wounds. These are made by a blunt 
instrument, and are accompanied by more or less 
crushing of the surrounding tissue. The external 
haemorrhage from them is apt to be slight, but there 
may be considerable bleeding into the tissues. 

2. Incised wounds. These are made by sharp 
instruments such as knives, glass, etc. 

3. Lacerated wounds. These are accompanied 
by tearing of the tissue. 

4. Punctured wounds. These are produced by 
pointed instruments or bullets. 

Treatment. — If there is haemorrhage, control it 
(see page 222). When an incised wound has been 
made by a sterile object, the ends should be imme- 
diately brought into apposition. If it is of any ex- 
tent, a surgeon should be notified, as unless the 
wound is sutured, an unsightly scar will result. 
Furthermore, if the wound is of any depth, some of 
the tendons or ligaments may have been severed 
and unless they are properly connected, loss of 
function will follow. If the wound is slight, wash 
the surrounding skin with soap and water, alcohol, 
or other disinfectant, and put on a sterile dressing. 

When the instrument or object causing the wound 
is unsterile, or the wounded part is dirty, syringe 
the wound with an antiseptic solution and scrub the 
surrounding parts well with soap and water and a 
disinfectant. If there is any hair about the part, 
remove it by shaving. Always examine such a 
wound for foreign particles and wash out from it all 
blood clots. Never close it entirely. As a rule, it is 
advisable to insert a small strip of gauze, catgut or 



Emergencies 231 

rubber tissue in its lower angle for drainage. To 
provide emergency sterile dressing, cut clean soft 
muslin or gauze the required size, and boil or other- 
wise sterilise it (see Chapter XIX). 

Before handling wounds, scrub and disinfect your 
hands. Be careful not to let anything unsterile come 
in contact with the wound. 

The Healing of Wounds. — When tissue is cut 
or otherwise injured, nature sends out cells, similar 
in composition to those of the tissue, which gradually 
assume in all ways the form of this tissue and which, 
by their growth, bring the walls of the incised flesh 
into complete apposition. In an uninfected wound, 
the edges of which have been brought into apposition 
soon after the accident, recovery takes place in a very 
short time and there will be but little inflammation 
around the incision. This is called ''healing by 
first intention," or "primary union." Wounds are 
said to heal by second intention when, owing to 
infection or failure to bring the edges of the wound 
into direct apposition, a greater amount of new 
tissue is required in the process of repair. In such 
wounds, red elevations, called granulations, appear 
on the surface of the forming tissue. These start 
from the sides and bottom and gradually fill up the 
wound. Sometimes, granulations grow too quickly 
or too large, and, in that case, an astringent, such 
as nitrate of silver, is applied to check their growth. 
When they are soft, or are not growing sufficiently, 
balsam of Peru is often applied to stimulate their 
growth. 

Medical Emergencies 

Apoplexy. — Apoplexy is generally due to pressure 



232 Practical Nursing 

on some part of the brain caused by haemorrhage 
from one or more of the cerebral blood-vessels. There 
is a sudden loss of consciousness, the face is usually 
flushed, and the pupils of the eye are fixed, one or 
both of them being dilated. The pulse, as in the 
majority of cases where there is brain pressure, is full 
and slow. The respirations are slow, laboured, and 
stertorous. There will be paralysis, usually hemiplegia. 
Convulsions and vomiting also may occur. 

Treatment. — To give first treatment to a victim 
of apoplexy, loosen his clothes, elevate his head and 
chest, and apply ice to his head, and warmth to his 
extremities. Do not give stimulants. 

Asphyxia. — Asphyxia is caused by a great diminu- 
tion of oxygen in the blood, due to the impurity of 
the air, or to an obstruction of the passage of air 
to the lungs. 

Treatment. — If the asphyxia is due to the latter 
cause, remove the obstruction if possible. In all 
cases, give plenty of fresh air, loosen the clothing, 
and dash cold water over the face and chest unless 
the body is cold, when hot applications should be 
used. If necessary, perform artificial respiration 
and treat for shock. Cessation of breath for longer 
than two minutes is usually fatal. 

Artificial Respiration. There are two methods of 
giving artificial respiration in common use, namely, 
Sylvester's and Marshall Hall's. To employ either 
method, the tongue must be first drawn forward and 
held so. If there is no assistant to hold the tongue 
out, tie a handkerchief or string around it, cross the 
ends, pass them round to the back of the neck, and 
tie them there. 

If you use Sylvester's method, lay the patient on 



Emergencies 233 

his back with his head and shoulders slightly elevated. 
Then, standing behind him, grasp his arms above 
the elbows and draw them slowly outward and up- 
ward till they meet over his head. Hold them in this 
position for two seconds and then flex them slowly 
but forcibly against the sides of the chest. The 
first motion causes inspiration, the second, expiration. 
The combined movements should be repeated sixteen 
times in a minute until respiration takes place natu- 
rally, or until all hope of resuscitating the patient 
has been abandoned. Resuscitation should not be 
considered hopeless until artificial respiration has 
been practised at least two hours. 

When Marshall Hall's method is used, the 
patient is placed upon his face, and pressure is made 
upon his back. He is then turned upon his side. 
After a few seconds, he is turned upon his face again, 
and pressure is reapplied upon his back. These 
movements are repeated sixteen times in the minute. 

Collapse. — Collapse is an almost complete failure 
of the vital powers. The symptoms are the symp- 
toms of shock intensified. The treatment is the same 
as for shock but with more stimulation. 

Convulsions. — Convulsions in adults are generally 
due to epilepsy, hysteria, uremia, poisoning from 
drugs, or bacteria. They also sometimes complicate 
pregnancy. They are then called eclampsia. 

Treatment. — To deal with a victim of convulsions: 
Keep him from hurting himself, but, beyond this, 
do not try to restrain his movements. Put something 
between the teeth to prevent him from biting his 
tongue. Loosen his clothing. Maintain him in a 
recumbent position, with the head slightly elevated. 
Give plenty of fresh air, but not stimulants. The 



234 Practical Nursing 

further treatment depends upon the cause of the 
convulsion. 

Convulsions in children are more common than in 
adults, and may mean little or much. They are often 
due to difficult dentition, excitement, indigestion, 
or worms. They also frequently usher in many 
serious diseases, particularly the exanthemata. Put 
the child in a hot bath 112-118 F. (see Chapter IX). 
Give an enema and, if possible, a dose of castor-oil. 

Drowning. — When you have to deal with a person 
who has been rescued from the water in an uncon- 
scious condition, you must resort to artificial respira- 
tion, but, before starting this, loosen his clothing, 
turn him face downward, raise his body at the waist 
line, to favour the emptying out of water from the 
trachea, and, then, clean out any accumulation of 
mucous from the back of his throat. As soon as 
possible, remove his wet clothes, put him between 
warm blankets, and, otherwise, treat for shock. 

Epilepsy. — Attacks of epilepsy (see convulsions) 
are generally succeeded by warning sensations known 
as the "aura, " the nature of which varies in different 
individuals. Attacks of epilepsy only last a few 
seconds. The mental condition of the confirmed 
epileptics becomes much impaired and insanity 
often results. 

Fainting. — Fainting or syncope is a state of un- 
consciousness caused by a sudden enfeeblement of the 
action of the heart. This may be due: 

1. To some form of heart disease. 

2. To temporary weakness of the heart by ex- 
haustion, as in extreme hunger, prolonged, excessive 
exertion, or even a slight amount of exertion if the 
person is in a weak condition. 



Emergencies 235 

3. To anything strongly influencing the nervous 
system. The action of the heart, being to a great 
extent under the control of the nervous system, any- 
thing tending to affect strongly the latter (pain, fright, 
or excessive emotion, for example) may bring on an 
attack of syncope. 

As the brain becomes anaemic in syncope, one of 
the first things to do is to lower the head. In fact, 
if a person threatened with syncope bends forward, 
when he first feels dizzy, so that his head will be 
lower than his knees, or lies dowm, keeping his head 
low, the attack will often be averted. Fresh air 
should be supplied in abundance and all clothing 
should be loosened. Cold water, thrown over face 
and chest, will, by causing enforced inspiration, 
often shorten the attack. Smelling salts or ammonia 
may be given by inhalation, but care must be taken 
in using the latter, not to let any drop into the eyes, 
and not to hold it too near the nose or mouth, as 
an intense irritation of the air passages may result. 

After a patient has recovered from an attack of 
syncope, keep him quiet until the proper action of 
the heart and circulation is re-established. 

Symptoms of Syncope. — In syncope, the face is 
pale, the pulse weak and somewmat accelerated, and 
the respiration shallow. The attack is generally of 
short duration. 

Hysteria. — One of the common forms of hysteria 
is a simulation of syncope. In the former, the patient 
is not unconscious, he will resist any attempt made 
to raise the eyelid, and there will be little, if any 
change in his colour, or in the rate and quality of his 
pulse beat. The same facts are true of hysterical 
convulsions, and in these, the patient seldom hurts 



36 Practical Nursing 



himself. Hysterical patients should be watched 
but, as a rule, the best treatment is to leave them 
alone. 

Intoxication. — The stupor of intoxication is 
often confounded with apoplexy, and, worse still, 
vice versa. In the former, the patient's pupils are 
generally evenly dilated, he can usually be partially 
aroused, and his breath smells of alcohol. He should 
be kept quiet and warm, and an emetic may be 
given. 

Poisons. — According to their action, poisons are 
classified as: 

i. Corrosives, which corrode and burn the tissues. 

2. Irritants, which irritate the tissues. 

3. Neurotics, which affect the nervous system. 
Treatment. — The treatment for poisons has three 

objects in view: to remove the injurious substance; 
to neutralise its further action; and to remedy the 
ill effects already produced. The first object is 
attained by the giving of an emetic or lavage. The 
second object is attained by giving a chemical anti- 
dote, which must be a substance that will not, by 
acting chemically upon the poison produce a com- 
pound which is either insoluble or comparatively 
harmless. The treatment resorted to for the at- 
tainment of the third object is known as the 
physiologic treatment. It consists in the giving of 
demulcent drinks, to counteract the irritation caused 
by the poison on the mucous membrane, and of such 
medication as will neutralise the effect of the poison 
upon the system. 

Emetics are seldom given after corrosive poisons, 
as the tissues would be still further corroded during 
emesis. Lavage is given when there is not too much 



Emergencies 



237 



abrasion of the tissue to prevent the passing of the 
tube. 

The emetics most commonly used are: 

Sodium chloride (salt) — two teaspoonsfuls in a glass 
of water, repeating the dose several times, if necessary. 

Mustard — two or three teaspoonsfuls in a glass of 
water. 

Apomorphine — gr. one-tenth to one-eighth given 
hypodermatically. 

Ipecac — mxxx of the fluid extract. 

Sulphate of zinc — grs. xx to xxx. 

These are all adult doses. For a child's dose, see 
Chapter XV. 

If no emetic is at hand, tickle the back of the throat 
with the finger. This will often produce emesis. 

In all cases except those mentioned above, give 
an emetic, and, if possible, lavage. If the stomach 
has not been well emptied of the poison, repeat the 
emetic or lavage, after giving the antidote, and 
follow by a second dose of the antidote. 



SYMPTOMS 


AND SPECIFIC TREATMENT AFTER 
COMMON POISONINGS 


THE MOST 


Poison. 


Symptoms of Poi- Chemical An- 

SONING. TIDOTE TREAT- 
MENT. 


Physiologic 
Treatment. 



Corrosive 
Acids: 
Acetic. 
Citric . 

Hydrochloric 
Nitric. 
Sulphuric. 

Oxalic. 



Corrosion of the mu- 
cous membrane, in- 
tense abdominal pain, 
livid, cold skin, small, 
irregular pulse, stupor, 
collapse. There may 
be convulsions. 

As above. 



Alkalies, soda, 
magnesia, chalk, 
lime -water. 



Chalk or lime. 
Neither potash 
nor soda can be 
used since their 
oxalates are poi- 
sonous. 



Demulcent 
drinks, as oil, 
milk, and albu- 
min stimulants, 
opium, external 
heat. 



As above. 



2 3 8 



Practical Nursing 



Poison. 



Symptoms of Poi- 
soning 



Chemical An- 
tidote Treat- 
ment. 



Physiologic 
Treatment. 



Carbolic. 



Hydro- 
cyanic 
Acid. 



Corrosive 

Alkalies: 
Ammonia. 
Caustic Pot- 
ash or Soda. 
Potassium 
Nitrate. 
Calcium. 

Irritants: 
Antimony. 



Arsenic. 



Bichloride of 

Mercury. 
Calomel. 
Blue 

Mass. 



Iodine. 



Lead. 



As above. Also 
odour of carbolic in 
breath, vomitus, and 
urine. Strangury and 
sometimes, retention. 
Smoky urine. 

Almost immediate 
loss of consciousness, 
eyes protruding and 
showing pupils dilated, 
pulse imperceptible, 
respiration very slow, 
odour of acid on the 
breath. 

Excoriation of tis- 
sue, violent abdominal 
pain, vomiting and 
purging of bloody mat- 
ter. Usual symp- 
toms of collapse. 



Epigastric pain, 
shrunken features, 

cramps of lower ex- 
tremities, convulsive 
spasms, collapse. 

Puffiness and itch- 
ing about the eyelids, 
i n t e n s e abdominal 
pain, violent vomit- 
ing, hiccough, intense 
thirst, straining, stools, 
bloody and offensive, 
collapse, sometimes 
convulsions 

Salivation, metallic 
taste, mucous mem- 
brane sometimes 
glazed and white, 
vomiting of blood and 
mucus, tenesmus, dys- 
enteric purging, dimin- 
ishing urine. Collapse 
after a short time and 
convulsions. 

Pain and burning of 
alimentary canal, 
vomiting, purging, yel- 
low stain about mouth. 

Slate coloured lines 
on the gums along 
margin of incisor teeth, 
colic, and other symp- 
toms of irritant poi- 
sons, paralysis of ex- 
tensor muscles of fore- 
arms. 



Sulphate o f 
magnesia, sul- 
phate of soda, 
lime-water, syrup 
of lime. 

Acts too quick- 
ly for any anti- 
dote to be of use. 
Give emetics and 
lavage. 



Mild acids — 
vinegar or lemon 
juice, sour cider. 



Tannic acid, 
strong tea. 



Hydrated ses- 
quioxide of iron 
to prepare, mix 
oz. viii of sol . mag. 
sulph. and oz. ii- 
iv of iron. Let re- 
main in stomach 
15 minutes, wash 
out, repeat two or 
three times. 

White of egg 
in water. One 
egg to every four 
grains of mer- 
cury, milk and 
flour paste. 



A paste of 
starch or flour 
and water. 

Sulphate of so- 
dium or magne- 
sium, white of 
eggs and milk. 



As above, but 
give no oil since 
oil hastens ab- 
sorption. Cathe- 
terise. 

Artificial res- 
piration, cold 
water to head 
and spine, stim- 
ulants, external 
heat. 



Heat, stimu- 
lants, milk, oil, 
white of eggs for 
ammonia. Cold 
air, artificial res- 
piration. 



Demulcent 
drinks, heat. 



D em u 1 c e n t 
drinks, heat, 
stimulants i f 
necessary, cathe- 
terise. 



Copious mu- 
cilaginous drinks, 
heat, stimulants 
if necessary. 



As for bichlor- 
ide of mercury. 



As above. 



Emergencies 



2 39 



Poison. 



Symptoms of Poi 
soning. 



Chemical An- 
tidote Treat- 
ment. 



Physiologic 
Treatment. 



Phosphorus. 



Gases. 



Neurotics: 
Aconite. ' 



Alcohol. 



Belladonna. 



Digitalis. 



Odour of garlic in 
breath, "coffee ground" 
vomitus, jaundice and 
usual symptoms of ir- 
ritant poisons. 



Embarrassed res- 
piration, frequent, 
weak, irregular pulse, 
cyanosis, dilated pu- 
pils, loss of sensibility 
in the conjunctiva. 



Characteristic ting- 
ling, pulse irregular, 
intermittent, and slow, 
respirations shallow, 
weak, sighing, and 
slow, anaesthesia of the 
surface, anxious ex- 
pression, eyes glaring, 
dilated, and protrud- 
ing. The mind is usu- 
ally clear, but there 
are often convulsions. 

(Acute poisoning.) 
A short period of ex- 
citement followed by 
coma, respirations ir- 
regular and stertorous, 
pupils either dilated or 
contracted, face flush- 
ed, pulse frequent and 
hard. 



General rash resem- 
bling that of scarlet fe- 
ver, pupils bright and 
staring, headache, ver- 
tigo, restlessness, and 
noisy delirium. 

Pulse irregular, slow, 
weak, face pale, eyes 
staring and prominent. 
Sclerotics blue, vomit- 
ing, great prostration, 
rapid respiration, con- 
vulsions. 



Crude French 
acid turpentine, 
in 3 ss doses 
every 15 min- 
utes. Use sul- 
phate of copper 
as emetic. Give 
purgatives. Nev- 
er give oils, since 
they hasten ab - 
sorption. 



Tannin. 



As above. 



Loosen all 
bands, lower 
head, heat, stim- 
ulants, fresh air, 
artificial respira- 
tion. Keep 
tongue forward. 
After illuminat- 
ing gas, phlebot- 
omy is often per- 
formed. 

Atropine, dig- 
italis, heat, keep 
head low, arti- 
ficial respiration. 



Heat to ex- 
tremities, cold 
applications to 
head, inhalations 
of ammonia. 



Catheterise fre- 
quently, hot 
mustard baths, 
cold affusion to 
head, artificial 
respiration. 

St rye h nine, 
keep patient 

quiet and in hor- 
izontal position. 



240 



Practical Nursing 



Poison. 



Symptoms of Poi- 
soning. 



Chemical An- ! 

tidote Treat 

ment. 



Physiologic 
Treatment. 



Chloral. 



Hyoscy- 



Nux Vomica. 



Opium. 



Respiration slow, 
irregular and shallow, 
pulse first weak and 
slow, then rapid, ir- 
regular and thready, 
coma, almost complete 
relaxation of the mus- 
cles, pupils contracted 
and then dilated. 

Either deep sleep 
and unconsciousness, 
or noisy delirium fol- 
lowed by coma, in- 
tense thirst, dilated 
pupils. 

Tonic convulsions, 
face livid, mouth con- 
tracted. — "risus sar- 
donicus," — eyes open 
and staring. Death is 
usually the result of 
paralysis of the res- 
piratory muscles. 

Intense desire for 
sleep, respiration slow 
and stertorous, con- 
tracted pupils, face 
first flushed, then pale, 
pulse at first full, slow, 
and strong, but grad- 
ually becoming rapid 
and weak, profuse per- 
spiration. Retention 
of urine is frequent. 



Tannic acid or 
tincture of io- 
dine. Follow 
immediately by 
emetics, as com- 
pounds thus 
formed are not 
permanent. 

Potassium per- 
manganate. 



Alcoholic stim- 
ulants, strong 
coffee, mustard 
pastes, hot foot- 
baths, elec- 
tricity, heat. 



Same as bella- 
donna. 



Absolute quiet, 
bromide chloral 
or chloroform for 
convulsions, ca- 
theterise to pre- 
vent reabsorp- 
tion. 



Keep patient 

awake, artificial 
respiration, at- 
ropine if neces- 
sary, strong 
black coffee by 
rectum and 
mouth. 



Local Poisoning from Poison Ivy. — In a case 
of ivy-poisoning, envelop the poisoned part in clean 
white cloths wet with a solution of bicarbonate of 
sodium. 

Poison from Bites or Stings of Snakes, etc — 
In a case of poisoning from the bite or sting of a snake 
or other venomous creature, ligate the wounded part 
above the point of injury, apply cupping glasses, 
cauterise the wound, and give stimulants to the 
verge of intoxication. 

Sunstroke. — Sunstroke, called also insolation, is 
marked by unconsciousness, as a rule, by congestion 



Emergencies 241 

of the face, stertorous breathing, a weak and fluttering 
pulse, and extreme hyperpyrexia — the temperature 
frequently rising to 115 F. and over. 

Treatment. — To treat a sunstroke, apply ice to 
the head and give ice-cold baths with constant friction 
till the temperature drops. As death may occur any 
moment from heart failure, watch the pulse care- 
fully, and take the temperature every five minutes. 
When it drops, remove the patient from the bath, 
apply heat to the extremities and give stimulants 
when necessary. Renew the cold applications, if 
the temperature rises. 

Heat prostration is a mild form of sunstroke. To 
treat* it, apply ice to the head, give cold baths, if 
necessary rubbing constantly, and keep the patient 
quiet. 

Sunstroke and heat prostration can be caused by 
intense heat of any kind. Exposure to the direct 
rays of the sun is not essential. Fatigue, foul air, 
and alcoholism will aggravate the danger. 



i5 



CHAPTER XVII 

BANDAGES, STRAPPING, AND SPLINTS 

Use, Nature, and Sizes of Bandages. How to Make Band- 
ages. Points to Remember in Bandaging. How to Make 
and Apply Plaster Bandages. Circular, Spiral, Spiral Re- 
verse, Recurrent, and Figure 8 Bandages. Bandages for the 
Head, Eyes, Jaw, and Breasts. Velpeau's Bandage. Spica 
of Shoulder. Hand, Arm, Elbow, Knee, Leg, Foot, and Heel 
Bandages. Tailed Bandages. Binders and Slings. Hand- 
kerchief Bandages. Strapping of Chest, Knee, and Ankle. 
Splints. Coaptation, Angular, and Volkman's Splints. 
Buck's Extension. Inclined Plane. Vertical Extension. 
Restraining Children. Bradford Frame. 

Bandages 

BANDAGES are used to keep applications and 
surgical dressings in place, to make compression, 
to control the circulation, to reduce swelling, to limit 
motion, and to afford support. 

They are most commonly made of either gauze, 
crinoline, muslin, flannel, Canton flannel, or rubber. 
Gauze is usually preferred for keeping dressings in 
place, because it is lighter, cooler, and more easily 
adjusted than the other materials. Crinoline, which is 
generally stiffened with plaster of Paris, is used to give 
support and prevent motion. Flannel and Canton 

242 



Bandages, Strapping, and Splints 243 

flannel are sometimes used under plaster bandages and 
splints to protect the skin. Flannel bandages are also 
used to reduce swelling and oedema, and when used 
for this purpose they are cut on the bias. Rubber 
bandages are used to afford support, as in weak 
ankles and varicose veins, and to control haemorrhage. 
Muslin 1 is used to keep splints in position and as a sub- 
stitute for other material. 

The average width and length of bandages are: i 
inch wide, 3 yards long for finger; 2 to 2^ inches 
wide, 6 yards long for head and extremities; 4 to 6 
inches wide, 8 yards long for the trunk. 

The different parts of the bandage are known as 
the roll, the initial and the terminal end, the outer 
surface and the inner surface. 

When each end is wound towar . the middle, 
forming two rolls, the bandage is called a double 
roller. 

Making Bandages. — Bandages must be smoothly 
and tightly rolled and all ra veilings removed. There 
are various machines for rolling bandages. On some, 
the whole width of the material is rolled at once, the 
bandages being cut the required width afterward. On 
others, the material is cut or torn into the required 
width before rolling. But whatever the machine 
used, never fail to hold the free end of the material 
firmly in order that the bandage may be rolled tightly 
and without wrinkles. 

To Make a Bandage by Hand. — Tear or cut the 
material the required width, remove the selvage and 
ra veilings. Fold one end of the strip several times 
upon itself. Then hold the free end of the strip very 

1 Choose muslin without dressing and that which is not too 
heavy. 



244 Practical Nursing 

tightly between the index and middle fingers of the 
left hand and roll with the right. 

To make plaster of Paris bandages: Choose fresh 
plaster of good quality and without lumps. Cut fine 
crinoline into strips the required length and width 
and spread and rub the plaster, unless there is a reg- 
ular machine for applying it, evenly into the meshes 
of the crinoline with a knife, spatula, or tightly-rolled 
bandage. Roll the strip loosely as each portion is 
finished. Store in an air-tight tin box. Wide plaster 
bandages should be rolled on sticks, since this pre- 
vents them from doubling when wet. 

Points to Remember in Bandaging. — Bandages 
must be put on tightly enough to insure their remain- 
ing in place. As a rule, except when there is inflam- 
mation, they should make a certain amount of 
pressure also. But they must never be tight enough to 
cause pain by impeding the circulation, and the pres- 
sure must be even. That it may be so, no one turn 
of the bandage must be tighter than another and each 
turn must overlap the other an equal distance. In 
bandaging an extremity, the toes or fingers are usually 
left uncovered, as it can thus easily be seen whether 
the bandage is too tight. If they become cyanosed, 
the bandage should be removed. Before bandaging 
a joint, always place the extremity involved in the 
position in which it will remain afterward. When 
bandaging the leg, always support it. For this pur- 
pose, a sand-bag is a good substitute for the regular 
heel rest. When putting on a spica of the groin, 
place a pillow, or two or three sand-bags, under the 
upper portion of the back so that the part under which 
the bandage has to pass back and forth will be raised 
from the bed. Hold the bandage roll side upperward, 




Bandages, Strapping, and Splints 245 

and bandage from the extremity toward the trunk, 
and from right to left. Always pin or tie the bandage 
so that the knot or pin will not come in contact with 
any part of the patient's body, 
or be where he will lie on it. 
Always use safety-pins for 
pinning. To tie, tear a few 
inches of the bandage, twist the 
two ends around each other, 
and pass one end in one direc- 
tion around the extremity and 
the other in the other direc- 
tion and tie over the twist. 

To Apply Plaster Baxda- Heel Rest - 

ges. — The requisites for applying plaster bandages 
will be : 

1. Two large rubber sheets one to protect the 
floor and the other, the bed. 

2. A doctor's apron. 

3. Two or three sand-bags. 

4. Sheet cotton; muslin, soft flannel, or thin Can- 
ton flannel bandage. 

5. Two strips of Canton flannel three inches 
wide, cut on the bias, long enough to go around 
the leg at both ends of the cast. These are called 
" cuffs. " 

6. Plaster bandages. 

7. A basin containing sufficient warm water to 
cover three or four bandages at a time. Salt, 3 ii to 
i quart, is generally added to the water, as it hastens 
the drying of the plaster. 

To prepare the extremity, shave it, wash it with soap 
and water, dry it well, and powder it. 

A few minutes before the doctor is readv for the 



24b Practical Nursing 

plaster bandages put two or three of them in the water. 
When the bubbles cease to rise, they are thoroughly 
soaked and ready for use. Put more in, as required. 
One should always be ready when needed. Squeeze 
the bandage gently to remove the surplus water, and 
pull off any ra veilings, before handing the bandage 
to the doctor. 

When required to hold a leg during the application 
of a cast, keep it in the exact position in which it is 
placed. 

Either a soft flannel or thin Canton flannel bandage, 
or a. layer of sheet cotton is put on under the plaster 
bandage, to protect the skin from the rough plaster, 
and a ''cuff" of Canton flannel is secured at either 
end of the cast. These "cuffs" are put around the 
leg and held in place by the first layer of plaster band- 
age. Three or four layers of plaster bandage are ap- 
plied, according to the desired strength of the cast, 
and the upper edge of the "cuff" is turned over and 
secured in place by the last layer. After the bandage 
is completed, some of the plaster in the bottom of 
the basin is rubbed over the surface of the cast. 1 

Leave the protecting rubber sheet on the bed until 
the cast is dry. Place sand-bags on either side of the 
extremity to keep it from moving and so breaking 
the cast. Leave the cast uncovered until it is dry. 
Never empty the plaster remaining in the basin into 
the hopper or closet, since it will harden and block 
the pipes. 

To Remove a Plaster Bandage. — To remove a 
plaster bandage, moisten it -in a straight line down the 
front (or wherever the opening is desired) with either 

1 Plaster bandages are never put on as tightly as other 
bandages. 



Bandages, Strapping, and Splints 247 



bichloride or dilute hydrochloric acid, and then cut 
it with a plaster knife or a strong pair of scissors. 

The Fundamental Bandages. — The fundamental 
bandages, on which the construction of the greater 
number of the special bandages are based, are the 
circular, the spiral, the spiral reversed, the figure-eight, 
and the recurrent. 

The Circular Bandage. — The circular bandage 
consists of two or three circular 
turns, each turn covering the 
preceding one. 

The Spiral Bandage. — The 
spiral bandage can be applied 
only to parts of uniform cir- 
cumference. It consists of cir- 
cular oblique turns, each one 
made higher than the preceding 
one, but overlapping it one-half 
its width. 

The Spiral Reverse. — The 
spiral reverse bandage con- 
sists of an ordinary spiral Circular Bandage. 
bandage with reverses. To 
make the reverse, place the thumb of the left hand 





Spiral Bandage. 
at the point where the reverse is to be made, pronate 



248 



Practical Nursing 



the right hand, in which the roll is held, thus doubling 
the bandage upon itself (see engraving), and make 




Spiral Reverse. 

traction on the bandage with the right 

hand to draw it well into place. Make 

each reverse directly above the preceding 

one. By thus reversing the bandage, 

the turns can be adjusted to the contours 

of the body. 

The reverse is principally used for the 

legs and arms. Simple Spiral 

below and the 
reverse above. 




Figure-Eight Bandage. 
The Figure-Eight Bandage.— The figure-eight 



Bandages, Strapping, and Splints 249 



bandage consists of a series of oblique turns alternately 
ascending and descending and crossing each other in 
such a manner that they form the figure-eight. The 
figure-eight is sometimes used instead of the reverse for 
the extremities; it is often used for the hands and feet; 
it is the foundation of the spicas and many other 
special bandages; and it is particularly valuable to 
retain dressing in place and to give support to the 
elbow and knee joints. 

The Recurrent Bandage. — The recurrent band- 
age consists of a series of turns passed back and forth 
across the part to be bandaged, each turn overlapping 
the other one-half its width. The ends are secured 
by a circular turn around them. The recurrent band- 
age is principally used to retain dressings in place 
on the ends of the fingers, toes, stumps, and the head. 

The Recurrent Bandage of the Head. — To apply a re- 
current bandage to the head: Fix the bandage by 
making two horizontal turns around the head. When 
the second turn comes to the centre of the forehead 
have the patient or an 
assistant hold it in place. 
Reverse the bandage and 
carry it across the head, re- 
verse, hold it in place with 
the thumb of the left hand, 
carry the roll across the 
head, overlapping the first 
row two-thirds its width and 
converging toward the centre, 
near the forehead. Repeat 
this turn on the opposite 
side of the first turn across the Recurrent Bandage . 
head. Repeat, carrying the bandage back and forth, 




250 



Practical Nursing 




first on one side and then on the other until the head 
is covered. Finish with a couple of circular turns 
around the head. 

The Capeline or Recurrent Bandage of the Head with 

Double Roller. — For a 
capeline bandage, use 
a double roller. To 
apply it: Place the 
centre of the bandage 
in the centre of 
the forehead, carry 
both cylinders to 
the occiput, reverse 
one end of the band- 
age turning it over the 
other which continue 
horizontally around 
the head to the fore- 
head, bring the re- 
versed end obliquely around the head, cross it with 
the horizontal end, reverse it over this, and carry 
it around the other side of the 
head. Repeat these turns, mak- 
ing every turn of the oblique 
bandage higher than the other, 
but over-lapping it two-thirds 
its width. Make each horizontal 
turn exactly cover the preceding 
one. 

Bandage for Front of Scalp. 
— To apply a bandage to 
the front of the scalp: Place 
the initial extremity of the 
bandage on one temple and fix 



Recurrent Bandage with 
Double Roller. 




Bandage for Front of 
Scalp. 



Bandages, Strapping, and Splints 251 



it by two circular turns. Carry the bandage down- 
ward, around the occiput, and upward, over the brow, 
covering the circular turn one-half its w T idth. Con- 
tinue obliquely downward around the nape of the 
neck, then up, crossing just above the ears over the 
front of the head, and down again on the left side. 

Bandage for the Side of the Head. — To apply a band- 
age to the side of the 
head: Fix the bandage 
with a couple of circular 
turns. On reaching the 
forehead the second time 
secure the bandage with 
a small pin. Reverse, 
carrying the bandage 
around the head to the 
nape of the neck, over- 
lapping the circular 
turn half its width. Re- 
verse, hold the bandage 
in place, and carry it back to the forehead still higher 

up on the side. Repeat the 
turns and complete with a cir- 
cular turn. 

The Monocle Bandage for One 
Eye. — To bandage the left eye: 
Place the initial end of the 
bandage on the left temple. 
Take a circular turn around 
the head from left to right and 
on to above the right ear. Then, 
carry the bandage down back 
of the head, up under the 




v. 

Bandage for Side of Head. 




Monocle Bandage. 



left ear over the cheek prominence and the eye , 



252 



Practical Nursing 




Monocle Bandage. 



lower edge of the bandage crossing the root of the nose. 
Pass the bandage over the right side of the head to 
the back and up the left side of the face, as before, 

covering one-half the width of 
the preceding and making 
the turn higher on the cheek 
and lower on the right side 
of the head. Make a third 
turn still higher on the cheek 
and lower on the head. Se- 
cure in place with a circular 
turn. 

In bandaging the right eye, 
place the initial extremity of 
the bandage on the right 
temple and carry the bandage 
from right to left. 

Binocle or Bandage for Both Eyes. — To apply a band- 
age to both eyes: Bandage the left eye in the man- 
ner already described. Carry 
the finishing circular turn to 
the back of the head and pin. 
Then, bring the roller upward 
over the left side of the head 
down over the root of the 
nose and the right eye. Cover 
this in the same manner as 
the left eye with the excep- 
tion of reversing the turns 
and bringing the bandage 
downward from the scalp 
over the eye, instead of car- 
rying it up from the face over the scalp. 

Barton s Bandage for the Jaw. — To apply a Barton 




Binocle Bandage. 



Bandages, Strapping, and Splints 253 





bandage to the jaw: Place the initial end behind the 
ear of the sound side, hold it in place with the thumb 
of the left hand, carry the roll across the nape of the 
neck under the occipital pro- 
tuberance, up behind the other 
ear, over the skull, down the 
sound side of the face in front of 
the ear, under the chin, and 
backward up the opposite side 
of the face. Cross the previous 
turn in the median line, and 
continue down behind the ear 
of the sound side around the 



Barton Bandage. 

neck over the chin, and 
back to the occiput. Repeat 
these turns two or three 
times, covering each one ex- 
actly. Finish with the turn 
which crosses under the chin. 
Pin on the top of the head. 

Suspensory Bandage for the 
Breast. — To apply a suspen- 
sory bandage to the breast : 
Place the initial extremity 
of the bandage on the left 
side of the chest, carrying it 
from left to right. Make 
two circular turns. On reach- 

Suspensory Bandage for in g the breast - incline the 

the Breast. bandage upward across 

the lower portion of the breast, over the opposite 



254 



Practical Nursing 



shoulder, down the back, around the body, and 
up again over the breast and shoulder, as in the 
first turn, overlapping it one-half its width. Repeat 
as often as necessary. The turns should overlap each 
other, forming the figure 8, under the most pendent 
part of the breast. 

Suspensory Bandage for Both Breasts. — To apply a 
suspensory bandage to both breasts: Fix the initial 

end of the band- 
age on the right 
side of the chest 
by two circular 
turns. On reaching 
the right breast for 
the second time 
carry the bandage 
over the opposite 
shoulder, down the 
back. Bring it 
forward to the 
right breast across 
the front of the 
chest, under the 
left breast cover- 
ing in one-half 
the circular turn. 
Carry it obliquely 
across the back, 
over the opposite 




Suspensory Bandage for Both 
Breasts. 



shoulder, down under the left breast, transversely 
around the back, across the right breast, and over 
the opposite shoulder. Then carry it again 

down the back, around the front of the chest, and 
over the left shoulder, crossing the breast as 



Bandages, Strapping, and Splints 255 



before. Repeat these turns until the breasts are 
covered. 

Velpeau's Bandage. — Before starting to apply 
Velpeau's bandage, place the hand of the injured side 
upon the sound shoulder, bringing the elbow opposite 
the point of the 
sternum, powder 
the skin between 
the arm and body, 
apply a thin layer 
of cotton, and place 
a pad in the axilla, 
and one over the 
seat of fracture. 
To apply Vel- 
peau's bandage : 
Put the initial end 
of the bandage in 
the axilla of the 
uninjured side. 
Carry the roll up 
behind the back, 
over the injured 
shoulder, and down 

across the middle 

£ , n ,! Velpeau's Bandage. 

or the arm, then r 

beneath the arm and across the chest to the sound 

axilla. Repeat the turn, covering the first. When 

reaching the arm of the affected side for the second 

time, pass the bandage around the body carrying it 

over the point of the elbow and then upward again 

to the sound axilla, across the back, over the affected 

shoulder, down in front of the arm, and then beneath 

it as before. Repeat these alternate vertical and 




256 



Practical Nursing 



transverse turns, until the vertical turns reach the 
point of the elbow. Complete by successive turns 
around the chest, until the forearm of the affected side 
is covered up to the wrist. Cover each of the vertical 
turns two-thirds their width, and the transverse turns 
one- third their width. 

Spica of the Shoulder. — To apply a spica of the 
shoulder: Fix the initial extremity by a couple of 
circular turns around the middle of the arm. Make 

spiral reverse turns 
until reaching the 
axillary folds. Then 
pass the bandage 
across the chest, 
through the oppo- 
site axilla, across 
the back, over and 
around the arm, 
crossing the reverse 
turn on its outer 
edge. Repeat these 
turns across the 
back, under the 
axilla, across the 
chest, and around 
the arm, until 
Spica of the Shoulder. the shoulder is 

covered. Cover each preceding turn on the arm and 
shoulder one-half its width, but converge the bandage, 
as it reaches the axilla on the second side of the body. 

Spicas in all parts of the body are done in the same 
manner. 

Bandage for the Hand and Forearm. — To apply a 
bandage to the hand and forearm when it is necessary 




Bandages, Strapping, and Splints 257 



to cover each finger separately : Begin at the tip of the 
first finger. Cover it, either by a succession of cir- 
cular turns or figures of 8, to its base. Then, take a 
turn around the wrist to keep these 
from slipping and return to the root 
of the second finger. Lead the band- 
age by one or two spiral turns to the 
tip, then proceed down it, as on the 
first finger, and conclude with another 
turn around the wrist. Cover each 
finger successively in the same way. 
Then take a wider bandage and 
make two circular turns around the 
base of the fingers. On reaching the 
centre of the back of the hand for 
the second time, pass the bandage 
obliquely across it, around the wrist, 
up across the back of the hand, 
crossing the other oblique turn in 
the median line, around the palm 
and down again across the back 
of the hand, making the turn lower 
on the hand but overlapping the former one-half its 
width. Repeat these turns till the hand is covered. 
Finish with a circular turn, or proceed up the forearm 
using either reverse or figure 8 turns. 

When it is not expedient to cover each finger sepa- 
rately : Put gauze or cotton between and over the tops 
of the fingers. Place the initial end of the bandage 
well down on the palm of the hand. Take recurrent 
turns back and forth across the tops of the fingers, 
covering each preceding turn one-half its width. 
Hold these turns in place with the thumb and first 
finger of the left hand, secure them with a couple of 




For Hand and 
Forearm. 



2,8 



Practical Nursing 




circular turns around the hand, and then proceed up 
the hand as already directed. If it is necessary to 
cover the thumb, do it first. Then, 
take a circular turn around the hand, 
hold the bandage in place with the left 
hand and start the recurrent turns 
over the fingers. 

Elbow Bandage. — Large joints such 
as the elbow and knee should not be 
involved in the bandaging of the 
extremities unless it is necessary. 
When it is necessary to cover the 



For the Hand. 

elbow and upper 
arm, proceed as 
follows: Continue 
the reverses until 
within two inohes 
of the elbow. 
Flex the forearm. 
Carry up the 
bandage directly 
over the elbow, 
having the point 
of the olecranon 
in the middle of 
the bandage. 
Bring the band- Elhow Band ^- 

age down inside the joint to the forearm, keep- 
ing the upper edge of the bandage just below the 
point of the olecranon. Cross it on the inside of the 




Bandages, Strapping, end Splints 259 



joint and carry it above and around the elbow, having 
the upper edge of the bandage just above the point of 
the olecranon. Repeat the turns, making those on the 
forearm lower and those on the arm higher than 
the first ones and covering them one-half their width. 
Make one circular around the arm and proceed up it 
with either the reverse, spiral, or figure 8. 

The knee is bandaged in the same manner as the 
elbow. 

Bandage for the Foot. — To apply a bandage to the 
foot: Take two circular turns around the roots of the 
toes, cross the arch 
of the foot, and 
encircle the ankle 
above the heel. 
Cross the arch of 
the foot, pass over 
and around the 
toes. Take alter- 
nate turns around 
the foot and ankle, 
making each one 
around the ankle 
lower on the heel 
and each one on 
the foot nearer the 
leg. Finish with a circular turn about the leg, or. if 
it is necessary to bandage the leg, take a circular turn 
around it and then proceed with either reverse or 
figure 8 turns. 

If the foot is long take two or three reverse or figure 
8 turns before carrying the bandage around the ankle. 

If it is necessary to cover the toes, use the recurrent 
turns, as when covering the fingers. 




For the Foot. 



260 



Practical Nursing 



Bandage for the Heel. — To apply a bandage to the 
heel : Take two turns around the heel. Carry the band- 




For the Heel. 

age over the arch of the foot and around the heel, 
having the upper edge of the bandage cross the lower 
edge of the heel. Proceed up over the arch of the foot 
and around the leg with the lower edge of the bandage 
overlapping the first turn half its width. Repeat. 

Finish with a circular turn 
around the ankle. 

Tailed Bandages and 
Slings. — Tailed bandages 
are very convenient for 
keeping poultices and other 
applications in place. 

The Four-Tailed Bandage 
of the Head. — To apply a 
four-tailed bandage to the 
head : Take a piece of mus- 
F our -Tailed Bandage lin eight inches wide and 
long enough to go over the scalp and tie under the 




Bandages, Strapping, and Splints 261 



chin. Cut it in the middle from each extremity to 
within four or five inches of the centre. Place the 
body of the bandage on the top of the head and tie 





Four-Tailed Bandages. 

the two posterior tails under the chin and the two 
anterior tails at the back of the neck. 

If it is desired to cover the back of the head, place 
the body of the bandage 
there and fasten the two 
posterior tails around the 
forehead and the two an- 
terior tails under the jaw. 

When the forehead is to 
be covered, place the body 
of the bandage there and 
fasten the two anterior 
tails at the back of the 
head and the two pos- 
t rior tails under the 
chin. Tail Bandage for Chin. 

Tail Bandage of the Chin. — To apply a tail bandage 
to the chin : Take a piece of muslin four inches wide 




262 



Practical Nursing 



and about thirty-six inches long and cut it in the mid- 
dle to within three inches of the centre. Place the 
body of the bandage on the chin. Tie the upper tails 
at the back of the neck and the lower tails on top of the 
head. Then tie the four tails together on the top of 
the head. 

The Four-Tailed Bandages of the Knee. — To apply a 
four-tailed bandage to the knee : Take a piece of mus- 
lin one and one-quarter 
yards long, and one-quarter 
of a yard wide and split it in 
the middle to within three 
inches of the centre. Place 
the body of the bandage over 
the knee. Carry the tails 
under the knee, cross them 
so that the upper ones will 
come below the joint and the 
lower ones above, bring them 
around and tie them in front. 
.4 Scultetus or Many-Tailed 
Binder for the Abdomen. — A 
scultetus or many - tailed 
binder is used on the abdo- 
men to obtain pressure or to 
Four-Tailed Knee Bandage keep applications and sur . 

gical dressings in place. To make it, take four or 




Scultetus. 
five strips of muslin three inches wide and a yard and 
a quarter to a yard and a half long, place them each 



Bandages, Strapping, and Splints 26, 



one overlapping the other half its width and sew the 
edges down in the centre for a quarter of a yard. To 
apply, pass half the bandage under the patient, in such 
a way that the sewed part 
will come under the back, 
and fold the strips alter- 
nately obliquely over the 
abdomen, crossing them in 
the centre. 

When this bandage is 
applied to keep a surgical 
dressing in place, the 
dressing should be further 
secured by a strip or two 
of adhesive plaster, and 
the bandage should be 
drawn as tightly as possi- 
ble without causing pain. 

in order that the sides of the wound may be held 
firmly together. 




Scultetus. 



I 



T -Bandage. 
To prevent the binder from slipping up. two tails 



264 



Practical Nursing 



(see engraving) are sometimes sewed or pinned to the 

lower edge of the binder. These tails are brought 

up between the legs and pinned in front. 

T-Bandages. — T -bandages, as the name implies, 

are cut in the shape of the letter T. They are gener- 
ally made of un- 
bleached muslin. 
If the muslin 
is doubled and 
stitched around 
the edges the 
bandage can be 
laundered and 
used for a long 
time. 

T -Bandage of the 
Perineum. — To 



T-Bandage. 



make a T-bandage: Cut the tails about four inches 
wide and a yard to a yard and a third long. The per- 
pendicular tail is 
sometimes slit up 
the centre to with- 
in three inches of 
the top, making 
what is called a 
double T-binder. 
To apply, fasten 
the horizontal 
arm around the 
waist, bring the T-Bandage. 

tail or tails up over or on either side of the perineum 
and fasten in place. 

Double T-Bandage of the Chest. — To make a double 
T-binder for the chest: Take a piece of material 



Bandages, Strapping, and Splints 265 



about eight inches wide and long enough to go around 

the chest, and sew to its upper edge, near the centre, 

about six inches apart 

two strips, two inches 

wide and fourteen 

long. To apply, pin 

the binder in the 

front, bring the straps 

over the shoulder and 

pin them in front. If 

necessary, pin a dart 

in under both breasts. 

Y-BlNDER FOR THE 

Breasts. — For a 

binder in the shape 

of a Y for the breasts, Double T -Bandage for the Chest. 

the tail should be eight inches wide, and long 

enough to reach across the back and meet the two 





1 . Y -Binder. 




2. Y- Binder. 



arms which cross the chest, and the arms should be 
four inches wide. Put one of these arms under, and 



266 



Practical Nursing 





the other above, the breasts and pin them to the tail. 

Shoulder straps can be added if necessary. 

Straight Binders. — Are generally made of a 

double fold of unbleached muslin stitched together 

round the edges. 

Straight Binder for the Abdomen. — Straight bind- 
ers for the abdomen are 
often used in obstetrical 
cases, after confinement. 
They should be about 
twelve to fourteen inches 
wide and long enough to 
go around the body. 

To apply, pin down the 
centre with small safety- 
pins, and pin darts on both 
sides, above and below the 
hip prominence. The lower 
darts are loosened when 
it is necessary for the pa- 
tient to use the bed-pan. 
Straight Binder for the Chest. — To make a straight 

binder for the chest, cut from a straight piece of muslin 



Straight Binder for 
Abdomen. 




Straight Binder for the Chest. 



a section long enough to go around the body and wide 
enough to extend from the neck to the waist and shape 



Bandages, Strapping, and Splints 26 



it to fit under the arms and around the neck. To ap- 
ply, pin it tightly down the front and over the shoul- 
ders, with small safety 
pins, and adjust it to 
the body by pinning 
darts under both 
breasts. These bind- 
ers are used to make 
pressure on the 
breasts, and to keep 
poultices and other 
applications in place. 
When using for the 
former purpose, pad 
the axilla between 
and around the 
breasts with non-ab- 
sorbent cotton and 
fasten the binder as 
tightly as possible. 
When using for the 
latter purpose, it need Straight Binder for Chest. 

not be put on as tightly and the darts are unnecessary. 

Slings. — To make a sling cut a square yard of mus- 
lin across diagonally. This will make two slings. 

When the forearm is injured, its whole extent should 
be supported squarely, and the sling is used for this 
purpose. To apply: Put the forearm in the centre of 
the sling. Carry the outer end of the sling over the 
arm and tie it, at the back of the neck or on the shoul- 
der to the inner end, after drawing this up between 
the arm and the chest. Bring the third point around 
the elbow and fasten in front. 

When the upper arm is injured the wrist only should 




2 68 



Practical Nursing 




be supported. In this case, to apply the sling, proceed 
as follows: Turn the hand, palm upward. Fold the 

sling. Place the 
wrist in the center 
of the folded sling, 
cross and knot or 
pin its ends a few 
inches above the 
wrist and then tie 
them around the 
neck. 

Handkerchief 
Bandages. Hand- 
kerchief Bandage 
for the Head. — To 
Slin g- apply a handker- 

chief bandage to 
the head: Place 
the base of the 
triangle on the 
nape of the neck 
and the apex over 
the forehead al- 
lowing it to hang 
down in front (as in 
engraving) . Knot 
the other two ends 
in front, turn the 
apex up over the 
knot and pin. 

Handkerchief Bandage for the Hand. — To apply a 
handkerchief bandage to hand: Place the base of the 
triangle at the front of the wrist, carry the apex up 
over the fingers, and fold the two extremities, one on 




Sling. 



Banddges, Strapping, and Splints 269 



either side, around the hand. Cross the ends, bring 
them around the wrist and tie. Pin the apex in place, 
if it does not come far enough up on the wrist to be 
secured by the points. 





1 2 

Handkerchief Bandage, 



Handkerchief 
Bandage. 



Handkerchief Bandage for Foot. — To apply a hand- 
kerchief bandage to the foot : Place the base of the tri- 
angle above the heel and bring the apex up over the 
toes to the front 
of the ankle joint. 
Fold the two ex- 
tremities down 
one on either side, 

over the instep, _~^<Z^^\\ \ 

around under the 
sole of the foot 

and back again to ^ — j*—±- 
the instep. Handkerchief Bandage for the Foot. 

Handkerchief Bandage of the Heel. — To apply a hand- 




2/0 



Practical Nursing 



kerchief bandage to the heel: Place the base of the 
triangle on the sole of the foot beneath the instep and 

the apex at the 
/ back of the leg. 
Bring the two ex- 
tremities up over 
the instep and 
round to the back 
of the leg. Cross 
and bring them 
once more round 
the leg and tie in 
front. 




Handkerchief Bandage for the Heel. 



Strapping 



Adhesive strapping is largely employed to insure 
the immobilisation of parts (as in strapping of the 
chest for fractured ribs and pleurisy) and to give sup- 
port and uniform pressure (as in injury to or disease 
of the knee, ankle, or other joints). Before strapping 
wash and shave the part which is to be strapped. 

Strapping the Chest. — The chest is strapped for 
fracture of the ribs in order that the bones by being 
kept immobile may have a better chance to unite. It 
is strapped in pleurisy also to give relief from pain by 
restricting the depth of the respirations. 

To strap the chest: Take either a piece of adhe- 
sive plaster long enough to extend from the far side 
of the spine to the sternum and wide enough to cover 
from just below the axilla to below the margin of the 
ribs, or, several pieces of adhesive plaster about two 
inches wide stuck together overlapping each other 
half their width. Prepare the chest by shaving and 



Bandages, Strapping, and Splints 271 



powdering. Place one end of the strapping on the 

spine. Make the patient take a deep breath and then 

"let out his breath," 

and, while the lungs are 

thus comparatively 

empty, quickly stretch 

the plaster and fix its 

free end over the far end 

of the sternum. Mould 

it to the body with the 

palm of the hand until 

all wrinkles are removed. 

To prevent the ends of 

the plaster from curling, 

put a narrow strip of 

adhesive plaster down 

both the back and the 

front. Strapping of the Chest. 

Another way of strap- 
ping is to use the narrow 
strips of plaster, two 
inches wide, applying 
each one separately. To 
do this: Cut a sufficient 
number of strips of 
plaster the correct size 
and make the patient 
"let out his breath" 
before the application of 
each strap. Overlap 

each strip half its 
Strapping of the Wrist. width 

To Strap the Wrist. — To strap the wrist: Cover it 
with one-inch strips of adhesive plaster, applying them 





272 



Practical Nursing 



tightly and letting each one cover the other half its 
width and extend about two-thirds around the wrist. 
Finish on either side with a narrow strip. Never put 
adhesive strappings entirely around an extremity. 





Strapping of the Knee. 

To Strap the Knee. — To strap the knee: Cut four 
pieces of one-inch adhesive plaster long enough to 
reach, when tightly stretched, from the middle of the 
leg just above and below the patella to the side of the 
latter. Cut twelve more strips, four of which are half 
an inch, four, an inch, and four, an inch and a half 
longer than the first ones. Surround the kneecap 
with the first four, stretching them very tightly and 
crossing them in the centre both above and below the 
patella and at the sides, thus forming the figure 8. 



Bandages, Strapping, and Splints 273 



Apply the next size in the same manner, over- 
lapping the first half their width, and so on. The 
strapping must be very tightly applied, without wrin- 
kles, and close to the patella. Cover with a tight 
figure 8 bandage. 

To Strap the Axkle. — To strap the ankle: Place 
the patient's heel on a stool, put a bandage back of 
his toes and have him hold the ends, so that his foot 
will be drawn for- 
ward. Stretch a 
piece of adhesive 
plaster down one 
side of the leg from 
about three inches 
above the ankle, 
crossing the point 
of injury. Pass it 
under the sole of 
the foot well toward 
the front and up 
the other side of 
the leg the same 
distance. 1 

Stretch a piece 
of one-inch plaster 
down one side of 
the leg (beginning three inches above the ankle) , under 
the heel and up the other side an equal distance. 
Place a strip at the back of the heel, bring one end 
around to just about the little toe and the other above 
the big toe. Put on alternate strips in this manner 
till the point of injury is well covered and finish with 

1 This strip is to help hold the foot in position. It is under 
the rest of the strapping and does not show in the engraving. 




Strapping oj the Ankle. 



274 Practical Nursing 

a narrow strip down either side, to prevent the ends 
curling. Never completely encircle the foot. 

Splints 

Temporary splints can be made of any material 
sufficiently stiff not to bend: umbrellas, canes, fire- 
wood, wooden slats, several thicknesses of cardboard, 
etc. If nothing stiff can be obtained, bandage the 
fractured leg to the sound one. Permanent splints 
are generally made of wood, tin, iron, or plaster. Bass- 
wood spints are pliable and can be fitted to an extrem- 
ity, but they break very easily. Hence they can only 
be used in connection with other splints or where 
there will not be much pressure. Splints of pine, 
about a quarter of an inch thick, are the wooden 
splints most frequently used. 

A coaptation splint is one made by fitting small 
strips of wood together upon cloth which adapts itself 
to the part. 

Splints must usually be long enough to extend 
beyond the joints above and below the seat of fracture. 
The side intended to be next the body must be very 
carefully padded, especially at the ends, otherwise 
pressure sores may result, to permit which is an un- 
pardonable crime. Splints are best padded with cot- 
ton wadding or non-absorbent cotton which is gen- 
erally held in place by bandaging. 

When a splint is to be applied have ready for the 
doctor some extra cotton for padding, adhesive plas- 
ter (strips of which are used to secure the splint in 
place), and bandages. 

There are two forms of angular splints, known as 
posterior and anterior respectively, both of which are 



Bandages, Strapping, and Splints 275 

frequently used for fractures of the elbow. The pos- 
terior splint is applied to the outer surface of the arm, 
and the anterior to the inner surface. The Volkman 
splint is much employed for fracture of the leg. 

These splints are padded and put on like the others. 

Plaster splints have already been described under 
bandages. 

There are a great many special splints and braces 
used both for fractures and in orthopedic work. 
Whatever the splint used the following rules must be 
observed : 

Keep the skin healthy by bathing with soap, water, 
and alcohol as often as possible. Powder it well to 
prevent chafing. Protect it from breaks or abra- 
sions by proper padding. Make the splints or brace 
sufficiently tight to remain in place, but never tight 
enough to interfere with the circulation. 

Extensions 

In fracture of the femur, it is generally necessary to 
make traction on the leg in order to overcome the con- 
traction of the muscles, which tends to displace the 
ends of the fractured bone. 

Buck's Extension. — Buck's extension or one of 
its modifications is very frequently used in such cases. 
The necessary articles to prepare when Buck's exten- 
sion is resorted to are : 

A pulley. 

A screw to attach the pulley to the bed. 

A rope and weights (the Volkman or other slide). 

Blocks to elevate the foot of the bed. 

A fracture board, if one is not already under the 
mattress. 



276 



V 

Practical Nursing 



Bed cradle. 

A splint, or splints, the kind to be specified by the 
doctor. 

Adhesive plaster. 

Bandages. Gauze bandages are generally used to 




MOLESKIN WITH BUCKLE ATTACHED 



Buck's Extension. 



fix the moleskin, and unbleached muslin ones, unless 
a plaster cast is put on, to secure the splint. 

Non-absorbent cotton, for padding. 

A spreader, made from a piece of wood about one 
inch wide and three inches long, on which a strip of 



Bandages, Strapping, and Splints 277 

one-inch webbing, long enough to extend about six 
inches on either side of the wood is tacked. There must 
be a hole in the centre of the wood through which the 
rope holding the weights can be passed and knotted. 

Matches, and an alcohol lamp, the latter to heat the 
moleskin. 

Two pieces of moleskin with suspender-buckles 
attached. The moleskin should be long enough to 
extend, when folded over the buckle from the side of 
the foot to the upper margin of the lower third of the 
thigh. 

To prepare the moleskin for use: Cut its end. 
Slip on the buckle, having the clasp on the non- 
adhesive side. Take off about four inches of the 
gauze protecting the adhesive surface, turn back 
the lower flap of moleskin over the bar of the buckle 
and stitch it around the sides and top of the flap, the 
moleskin not being sufficiently adhesive in itself to 
stand the strain of the weights. 

Do not remove the protecting gauze from the upper 
part of the moleskin until the doctor is ready to use it. 
After removing the gauze, heat the moleskin, holding 
the non-adhesive side facing the flame. Prepare the 
leg by washing and shaving it. 

To apply the moleskin: Fasten it to the sides of the 
leg having the buckles just escaping the side of the 
patient's foot, and as it does not always stick very 
firmly at first, secure it generally, by a gauze bandage. 
Put on a splint or heavy bandage, fastening the ends 
of the webbing on the wooden cross-bar into the buck- 
les. Put one end of the rope through the hole in the 
bar and knot it firmly, and pass the other end over 
the pulley and the weights attached to it. 

Raise the foot of the bed on shock blocks. Put a 



2 7 8 



Practical Nursing 



bed cradle over the bed to keep off the bed-clothes. 
While changing the bed, or performing any other duty 
that involves much moving, rest the weights on the 
foot of the bed to relieve the traction. 

The Inclined Plane. — Another device for procur- 
ing extension is the inclined plane. It consists of 
three pieces of wood, the under piece having bars across 




one end, to allow the adjusting of the upper plane, and 
small poles on either side, to keep the same from slip- 
ping out of position. The upper pieces of the plane 
are joined by a hinge and there is a foot piece on the 
lower one of these. 

Except that no weights, pulley, rope, or slide will 
be needed, the articles to prepare, when an inclined 
plane is to be used, are the same as for a Buck's exten- 
sion. The webbing is fastened in the buckles and tied 
on the lower pole of the plane. 

Vertical Extension. — Vertical extension is often 
used for fractures of the femur in young children. 

The articles required are, with a few exceptions, the 
same as for the Buck's extension. A bar to go over 
the bed replaces the weights, and, as both the injured 
and uninjured leg are suspended, there must be two 
wooden cross-bars with webbing attached, two pieces 
of rope, and four pieces of moleskin and buckles. 

The pulleys are attached to the bar above the bed. 



Bandages, Strapping, and Splints 279 

One end of each piece of rope is put through the wood 
and knotted, as in the Buck's extension, and the other 
end is passed over the pulley and tied to the foot of 
the bed. 

To cover the child's legs, pin a folded sheet neatly 
around them and also to the rope, to hold the sheet in 
place. 

To protect the chest, put a folded sheet or a doubled 
blanket folded in a sheet across it, and tuck the ends 
in under the mattress. 

The Bradford Frame. — The Bradford frame is an 
appliance much used for restraining children and. in 
cases of fracture, for providing a surface which will not 
sag as a mattress does. It consists of a frame of gas 
piping, which should be a few inches longer than the 
patient and wide enough to prevent his shoulders from 
resting on the frame. A strong piece of canvas is 
stretched very tightly around either end of the frame. 
Between these strips of canvas there is an aperture 
where the buttocks will rest. This space is left to 
allow the child to use the bed-pan without removing 
the frame. 

To immobilise the body: Put on a restraining 
jacket 1 and pin it at the side under the rim of the 
frame. Pin the shoulder straps over the top of the 
frame. Pass bandages through the "buttonholes" 
in the lower edge of the binder and tie them to the 
bottom rim of the frame, to prevent the binder from 
slipping up. The binder must not be tight enough 
across the chest to restrict the breathing, but it can, 
except in abdominal and hip cases, be made more 

1 This consists of a straight binder with armholes and shoul- 
der straps. The body of the binder should extend from the 
neck to below the hips. 



28o 



Practical Nursing 



secure around the hips. A straight binder can be 
pinned across the legs, if necessary. 

When there is danger of bed sores at the end of 





: n 

1 1 

• 1 

1 ,' 

1 
1 

j : 
• ■ 

■ : 
i • 
i j 

■ , 

i 




1 1 

1 1 

1 1 

1 ' 
t 

j J 

1 




• 
1 
1 

1 
1 

1 

I 

1 
1 

t 
1 






c 


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the spine, pressure on it can be relieved by raising the 
frame a few inches from the bed, and tying it to the 
bed-posts. 



CHAPTER XVIII 

PREPARATION FOR GYNECOLOGICAL TREATMENTS 

Gynaecological Positions. How to Prepare the Patient for 
Examination. How to Hold the Sims Speculum. 

THE delicate nature of the diseases peculiar to wo- 
men renders it highly desirable that the nurse 
should display consummate tact in gynaecological 
cases. Otherwise she may alarm the modesty or 
wound the sensibilities of a patient. Now the surest 
foundation for such tact is a knowledge of the princi- 
ples of gynaecology 1 and deftness. Hence the nurse 
should spare no pains to acquire both. It is espe- 
cially important that she should familiarise herself 
with the position in which a patient is placed for 
gynaecological examination, operation, and treatments. 

Gynaecological Positions 

The following are the most common gynaecological 
positions : 

i. Dorsal Recumbent Position. — In the dorsal 
recumbent position the patient lies flat on her back, 
with her knees flexed and separated. 

2. Dorsal Lithotomy Position. — The dorsal 
lithotomy position is the same as the dorsal recumbent, 

1 Gynaecology is the science that treats of the diseases of the 
uterus and its appendages. 

281 



282 Practical Nursing 

except that the buttocks and hips are elevated and 
the thighs flexed on the abdomen and held in position 
by a crutch or a folded sheet passed under the knees 
and fastened, either around one shoulder, or the back 
of the neck. 

3. Horizontal or Supine Position. — In the hori- 
zontal position, the patient lies flat on her back, with 
her legs either extended or slightly drawn up to relax 
the abdominal muscles. 

4. Knee-chest Position. — In the knee-chest po- 
sition, the patient rests on her knees and chest, with 
her knees slightly separated, her thighs perpendicular, 
her legs extended, her head on one side and the arms 
free at either side — never under the chest. She must 
be supported while in this position. 

5. Left Lateral or Sims Position. — In the left 
lateral position, the patient lies on her left side. The 
body is extended diagonally from right to left. The 
thighs are flexed at about right angles with the pelvis, 
the right one being drawn up more against the abdo- 
men than the left. The left arm is thrown across the 
back and the right arm is loose at the side. The chest 
is rotated forward so that it comes in contact with the 
table, the spine being fully extended and the head 
resting on the left parietal bone. 

6. Standing or Erect Position. — In the standing 
position, the patient stands with her knees separated 
about ten inches, one foot on a low stool and one hand 
on a table or other support. 

7. Trendelenberg Position. — In the Trendelen- 
berg position, the patient lies on her back, her thighs 
elevated against an inclined plane and her legs, from 
the knees, hanging down on its other side, and tied. 

In the hospital, there is a specific table adjustment 



Gynaecological Treatments 283 

for this position. In a private house, an inverted 
chair fastened to the end of a narrow table, is a good 
substitute. 

Preparing the Patient for Examination 

Before placing the patient in position, loosen her 
clothing, cover her with a sheet, tuck her clothing up 
out of the way and see that the genitals are scrupu- 
lously clean. In the hospital, a douche 1 is very fre- 
quently given before examinations, and, if the bowels 
have not moved within the last twelve hours, an 
enema. 

When the patient is in the dorsal position, drape 
the sheet in either of the two following ways: 

1. Gather the lower edge up in the centre, so that 
the vulva, but the vulva only, will be exposed, and 
twist the ends around the feet to secure them in place. 

2. Proceed as above, but allow the ends of the 
sheet to hang loosely over the legs and feet, securing 
them in position by tucking the upper corners under 
the buttocks. 

For both of these methods, fasten a towel under 
the sheet, allowing one end of it to fall over the vulva. 

When the patient is in the Sims position, cover her 
body with a sheet, secure it in place by tucking one 
end under her legs, gather it up in the centre so as to 
expose the vulva, and put a towel under the sheet (as 
in the dorsal position), allowing it to fall over the 
vulva. 

When the patient is in the knee-chest position, cover 

1 A douche is seldom given before the first examination. The 
majority of physicians wishing to see the character of the dis- 
charge, if any, and the general condition of the vaginal walls 
before any changes have been made by a douche. 



284 Practical Nursing 

her back with the centre of the sheet and her legs with 
the ends, pin these ends to secure them in place, gather 
the sheet away from the vulva and cover the vulva 
with a towel. 

To drape a patient in the erect position, pin a sheet 
around the waist, allowing it to fall around the legs 
like a skirt with the opening at one side. 

Holding the Speculum 

The bivalve speculum is generally used when the 
patient is in the dorsal position, and the Sims, when 
she is in the Sims position. To hold the Sims specu- 
lum : Stand on the left side of the patient resting your 
left arm lightly on her hip. Separate the buttocks 
near the vaginal opening with the left hand. Take 
the speculum in the right hand, grasping it firmly 
by the handle with the hand proper on the outer side 
and the thumb and fingers on the inner side — next 
the patient. Hold it firmly, making even traction. 

Objects, Required for Gynaecological Examinations 

A rubber glove and emulsion of white soap or other 
lubricant is sometimes all that is required for gynae- 
cological examinations. At other times a speculum, 
either bivalve or Sims, and a uterine sound will also 
be needed. When any application is to be made, the 
usual requisites, in addition to the objects already 
named, are uterine and dressing forceps, an applica- 
tor, a sponge holder, -scissors, sponges, tampons or 
gauze packing, and the specific disinfectant or lotion. 

In the hospitals there are special tables for gynae- 
cological work. When such a table is not to be had, 
any strong narrow table can be used or the patient can 



Gynaecological Treatments 285 

be placed crosswise on a couch or bed. In the latter 
case, the buttocks should be at the edge of the bed, 
and the feet, if the position is the dorsal one, should 
rest on chairs. The chairs must be so placed that 
they will be out of the physician's way. 

Making of Tampons 

For the method of making tampons see Chapter 
XXII. 

Removing Uterine Supports 

There are several forms of uterine supports. Of 
these, the Hodge pessary (or one of its variations) is 
perhaps the most common. It frequently happens 
that a pessary must be removed by a nurse. To re- 
move a pessary introduce the index and middle fingers 
into the vagina, bend the index finger over the ante- 
rior bar of the pessary, give it a slight turn, and pull it 
gently down. 



CHAPTER XIX 

SURGICAL DRESSINGS 

The Sterilisation and Cleansing of Instruments and Uten- 
sils for Surgical Dressings. The Preparation for, and Dress- 
ing of Wounds. 

AS has been already stated (see Chapter II), the in- 
troduction of germs into a wound may not only 
interfere with its healing, but may even cause the 
death of the patient. Therefore, it is necessary that 
everything which will come in contact with a wound 
be made sterile, and also everything which, though 
not coming in contact with the wound itself, may 
touch something that will. 

Sterilisation and Cleansing of Instruments 

The following are some of the rules to be observed 
in sterilising and cleansing instruments, utensils, etc., 
to be used for surgical dressings : 

Sterilisation. — Boil blunt instruments for five 
minutes and sharp ones for thirty seconds in a i% 
solution of sodium carbonate. 

Never put instruments into the steriliser until the 
water is boiling. 

Always put them in blunt end foremost. 

Always open or unclasp scissors and other hinged 
instruments before putting them in the steriliser. 

286 



Surgical Dressings 287 

Wind cotton or gauze around the blades of scalpels 
and bistouries. 

Remove the wires from needles and run wires and 
needles into gauze. Protect the points carefully. 
Wipe the wires on sterile gauze, if the needles are not 
to be used immediately, and put them back in the 
needles to prevent rusting. 

Cleansing. — Wash from the instruments with cold 
water all blood and discharge. 1 Sterilise them. 
Scrub them on a board kept for the purpose, with a 
nail brush, using pearline, Bon Ami, or whiting, and 
hot water. Dry them thoroughly with soft gauze, 
when they are perfectly clean. Dry the inside of 
needles by alternately inserting and removing the 
wire, drying it each time before reinserting. Always 
put needles away with wires in them. As they can 
easily be gathered up with the towels and soiled dress- 
ings, and thus lost, always count instruments before 
starting to clean them, and again before putting them 
away. 

The proper cleaning of instruments after use is very 
essentia , both to preserve them and to insure their 
proper sterilisation when required for use. 

Sterilisation and Cleansing of Syringes and 
Exhaust Pumps. — The method of sterilising a syringe 
depends upon the material of which the syringe is 
made. When made purely of glass it can be boiled. 2 
Put it into the steriliser while the water is cold, other- 

1 Nearly all the fluids of, and discharges from, the body con- 
tain albumin. Heat coagulates albumin and makes it hard 
to remove. 

2 There are some rubber packings which are ruined by boil- 
ing. Syringes with asbestos packings can always be boiled. 
Leather washers cannot be boiled. 



288 Practical Nursing 

wise the glass may be broken. Boil five minutes. 
After boiling, test it to see that it is in working order. 
If boiling would spoil the syringe, disinfect it by alter- 
nately drawing in and expelling alcohol or ether sev- 
eral times, and washing the outside with alcohol. 

To clean syringes, wash them inside and outside 
with first, cold water, then, hot water and soapsuds. 
After washing sterilise or disinfect and dry. There 
are some syringes which are ruined by being taken 
apart. Dry such by drawing ether into the barrel 
and then expelling it, and, afterwards, moving the 
piston up and down gently until the glass is dry and 
polished. 

Exhaust pumps, such as are used to exhaust the air 
in the bottle for aspirations, must not be confounded 
with syringes. Drawing fluid into or boiling these 
invariably ruins them. 1 

Wash off the outside of an exhaust pump, both be- 
fore and after use, with (i) green soap and water, and 
(2) w T ith alcohol, and then roll in gauze wet in carbolic 
1-40 and leave until wanted. 

Sterilisation and Cleansing of Solution Ba- 
sins, Lotion Glasses, and Kidney Basins. — Steril- 
ise a solution basin, lotion glass or kidney basin either 
by boiling, exposure to steam pressure under, or by 
soaking in a disinfectant the length of time required 
to render it sterile. To clean, wash (1) with cold 
water and (2) with hot water and Bon Ami. A kidney 
basin which has been used as a receptacle for soiled 
dressings, or to catch the discharge from wounds, 
must be either sterilised or disinfected after use, as 
well as before. 

1 It must be remembered that this pump is not really sterile, 
and precautions must be taken accordingly when using it. 
19 



Surgical Dressings 289 

Sterilisation axd Cleansing of Rubber Tub- 
ing. — To sterilise rubber tubing, boil for five minutes 
in a one-half % solution of sodium chloride. As rub- 
ber tubing will float, it is well, when sterilising long 
pieces, to tie them in gauze. 

To clean rubber tubing, insert a funnel in one end 
and let a plentiful supply of (ij cold water and (2) hot 
water run through it. Dry by stretching through 
the fingers until no water appears at the outlet, and 
then allow it to hang for some time before putting it 
away. When necessary to put the tubing away ster- 
ile, keep it in a sterile towel while stretching and 
stretch for a longer time, but do not hang it up. 

To Cleanse and Disinfect Dressing Rubbers. — 
Dressing rubbers are not, as a rule, disinfected before 
use. After use, wash off all blood or discharge with 
cold, water, soak them in a disinfectant the required 
length of time then, scrub with Bon Ami and hot 
water, using a brush. Disinfect and cleanse. 

To Sterilise and Cleanse Rubber Gloves. — To 
sterilise rubber gloves which are wanted for immedi- 
ate use, boil for five minutes. After use, wash them 
with (1) cold water and (2) with hot water and soap 
and dry and powder with talcum both inside and out. 
If they are to be put away sterile, use a sterile towel 
and powder, wrap them in a cover of sterile unbleach- 
ed muslin and sterilise for ten minutes at fifteen 
pounds pressure, temperature of 250° F. 

Preparation and Sterilisation of Gauze Used 
for Surgical Dressings. — To avoid handling dress- 
ings after they have been sterilised, those for each 
patient, with the necessary sponges, should be done 
up in a separate bundle and rolled in a cover of un- 
bleached muslin (for method of sterilisation, see Chap- 



290 Practical Nursing 

ter II.). The bundle should not be opened until the 
dresser requires its contents. 

All gauze and sponges not used for a dressing 
should be kept and resterilised. 

An extra supply of sterile dressings and of separate 
packages of gauze, sponges, and absorbent cotton, 
should be kept in each ward ready for each person. 

Care of the Hands. — For care of the hands, see 
Chapter I. 

Disinfection of the Hands. — In the glands of 
the skin and underneath the nails, millions of bacteria 
are lodged. As the hands cannot be subjected to a 
sufficiently high temperature or immersed in solution 
long enough to kill these germs, they are never really 
sterile. Therefore, rubber gloves are now nearly 
always worn during operations, and very frequently 
during the preparation and application of dressings. 
When gloves are used the following regime is generally 
considered a sufficient preparation for dressings: 

Scrub the hands for three minutes with soap and 
hot water changing the water and using a sterile nail 
brush. 1 Clean the finger nails with a blunt-pointed 
sterile orange stick. Scrub the hands again for two 
minutes with bichloride of mercury solution 1 :iooo, or 
70% sublimate-alcohol 1 in 100. Rub dry and polish 
with a sterile cloth. 

When the gloves are not worn, twice the time must 
be spent in scrubbing the skin. 

General Suggestions 

Not only must everything used for surgical dressings 

1 Nail brushes when new are bleached in oxalic acid by soak- 
ing for twelve hours. They are boiled daily for ten minutes 
and kept in a solution of carbolic 1-20. 



Surgical Dressings 291 

be made sterile, but the dressings themselves must be 
kept sterile, and it requires constant watchfulness 
and thought to keep them ro. Some of the com- 
mon careless blunders in asepsis are: pouring out 
solutions and lotions without washing off the rims of 
the bottles with a disinfectant; placing stoppers and 
covers inner side down on an unsterile table; and 
touching an unsterile object with the hands after 
disinfection. 

If a sterile object comes in contact with anything 
unsterile, it must be resterilised before being used. 

In some hospitals, everything required for all the 
dressings is placed on a dressing carriage, which, when 
there is no dressing-room, is wheeled from bed to bed. 
This saves time, but the asepsis can hardly be as 
strictly maintained as when individual dressings are 
prepared. .When the individual dressing method is 
employed, put everything for a patient's dressing, 
on trays, or, if the bedside tables have glass or metal 
tops, on a table, after having washed either tray or 
table top with (i) green soap and water, (2) a disin- 
fectant — bichloride 1-1000 or formaldehyde 1-500 are 
most frequently used — and covered it with a sterile 
towel. Place on this sterile towel all sterile requisites 
for the dressing, i. e., the package containing dressing 
and sponges; the instruments — probe, scissors, and 
forceps are the ones most frequently used — a syringe 
or irrigator, if the wound needs irrigation; solution 
basins containing necessary solutions— two ounce 
glasses are employed for such solutions as peroxide 
where only a small amount of solution is used ; a kid- 
ney basin 1 ; and rubber tubing or rubber tissue, if 

a The kidney basin should be put under the towel covering 



292 Practical Nursing 

required. Then cover these objects with another 
sterile towel. 

Use this second towel during the dressing to cover 
the bed-clothes or the dressing rubber, next the 
wound, placing the side that has been touching the 
sterile objects uppermost. 

The unsterile requisites most commonly used are 
a dressing rubber or a Kelly pad or, if there is much 
irrigation, both; a paper bag for soiled dressing; ad- 
hesive plaster; and a binder or bandage. Place these 
on a lower shelf of the table. 

The unsterile articles should be arranged either be- 
fore or after the sterile ones. Preferably before, espe- 
cially if the "dressing jars" are to be filled. Glass 
jars 1 with wide ground-glass rims which keep cover and 
jar tightly together, thus rendering them compara- 
tively air-tight are the best things in which to keep 
sterile dressings, etc. These jars should be emptied 
daily and the contents sent to be resterilised. They 
should be well washed and disinfected before being 
refilled. If not practicable to disinfect the jars thor- 
oughly, the gauze, absorbent cotton, etc., should be 
left in the coverings in which they were sterilized. 

When several dressings are to be done at a time, 
there ought, if possible, to be two nurses present, — ■ 
one, to assist the dresser, and the other, to prepare in 
advance the patient next to be dressed, to put on the 
bandage or binder of the patient just dressed, and to 
resterilise the instruments. 

the tray. Though it is disinfected, it is used for such unsterile 
purposes that it is better not to have it come in contact with 
the dressings, etc. 

1 When glass jars cannot be afforded, tin boxes, stone, or 
other jars which can be thoroughly cleansed, are used. 



Surgical Dressings 293 

When assisting with a dressing, a nurse should 
watch the surgeon closely and anticipate his wants. 
A good nurse has seldom to be asked for anything. 

When removing a dressing from a wound, never 
pull it off forcibly. If it adheres to the wound, wet it 
with solution. In lifting it, pull from both sides 
toward the centre to avoid separating the edges of the 
wound. If the wound is sutured, be very careful not 
to pull the stitches. 

When doing a dressing, be thorough, but gentle in 
your work. It is false kindness to half-do it for fear 
of hurting. When using nitrate of silver, or other 
caustic, to burn off granulations, be careful to touch 
the granulation only, and not the edges of the wound 
or skin. Wash all blood and other discharges off the 
skin before putting on the dressing. If these are dry, 
or not easily removed, use alcohol or ether. Wash 
from the wound, to avoid getting anything into it ; but 
hold its edges in apposition while doing so, to prevent 
breaking up the new tender tissue growth and thus 
retarding the healing process. Apply the bandage 
or binder as tightly as possible without interfering 
with the circulation, that the edges of the wound may 
be held firmly together, and that the dressings be held 
strictly in place. 

Cleanse and disinfect the hands before beginning, 
and between dressings, in the same manner as before 
preparing them. 

Always dress clean, before suppurating, wounds. 

Always .reinforce a dressing, as soon as discharge 
comes through it. Not only does the soiled dressing 
look untidy, but the gauze is no longer impervious to 
germs. 



CHAPTER XX 

TREATMENT REQUIRING ASEPTIC PRECAUTIONS 

Preparation for Aspiration of the Abdomen, Thorax, and 
Pericardium. Exploration of the Thorax and Other Cavi- 
ties. Lumbar Puncture. Phlebotomy. Hypodermoclysis. 
Infusion. Intravenous Infusion. Injections of Antitox- 
ine, etc. Intubations. Throat-Cultures. Blood-Smears 
and Cultures. 

IN preparing for aspiration of the abdomen, thorax, 
and pericardium, exploration of the thorax and 
other cavities, intubation, throat cultures, lumbar 
puncture, hypodermoclysis, infusion, intravenous in- 
jection, and injection of antitoxine, etc., the same 
aseptic precautions must be taken as in preparing surgi- 
cal dressings. When all these precautions have been 
taken, place all sterile articles on a disinfected tray, 
covered with a sterile towel. Cover them with a sec- 
ond sterile towel. When the doctor is ready to begin 
the operation, this second towel is placed sterile side — 
the side which has been next the sterile objects — up- 
permost, over the bedclothes near the point of punc- 
ture. The doctor does this unless the nurse's hands 
are sterile. 

Aspiration 

Aspiration is the withdrawing of liquid from the 

closed cavity. 

294 



Aspiration — Aseptic Precautions 295 

Abdominal Aspiration. — Abdominal aspiration, 
or withdrawing of liquid from the abdominal cavity, is 
generally called paracentesis. Cirrhosis of the liver 
is the disease most commonly complicated by an ex- 
cessive collection of fluid in the abdomen, and ascites 
is the name given to this collection. 

The instruments 1 required for abdominal aspiration 
are: 

1 . Canula and trocar. 

2. Scalpel. 

3. Probe. 

4. Scissors, forceps, two needles. 
There will also be needed : 

1. Twelve sterile sponges. 

2. A dressing, consisting of two pieces of sterile 
gauze and one large piece of absorbent cotton. 

3. Silk. 

4. Two sterile towels. 

5. Adhesive plaster. 

6. A binder — preferably, a scultetus. 

7. A sterile funnel with long rubber tubing con- 
nected. 2 This is intended to convey the fluid from the 
canula to a jar standing on the floor. 

8. A slop jar to catch the liquid. 

9. Two rubber sheets 3 one to protect the floor, and 
the other, the bed-clothes. 

10. Sterile glasses containing the disinfectants 

1 For the sterilisation and cleansing of instruments, see 
Chapter XIX. 

2 There are some canulas to which the tubing can be at- 
tached. A funnel is not then necessary. 

3 Table oil-cloth, heavy paper, or several thicknesses of 
newspaper can be used in private and district nursing, in- 
stead of rubber sheets. 



296 Practical Nursing 

usually used for the preparation of the skin for minor 
operations (see Chapter XXII). 

11. Stimulants (as ordered). Stimulation should 
always be at hand during the performing of any of 
these operations, as it is often required unexpectedly. 

12. Hypodermic syringe ready for use and loaded 
with cocaine. 

13. Laparotomy stockings and slippers. 

14. Extra pillows. 

1 5 . Two bandages. 

16. Two blankets. Only one will be required if 
the patient does not sit up. 

Preparation of the Patient. — To prepare the 
patient for abdominal aspiration, shave his abdomen, 
scrub it with green soap, and, after he is in position, 
with the disinfectants usually used in the preparation 
for minor operations. In some hospitals, this final 
scrubbing is done by the doctor. The hands of the 
person doing it must be sterile. Many doctors require 
women patients to be catheterised before paracentesis. 

Freer drainage can generally be obtained if the pa- 
tient is able to sit up in bed with his legs over its edge. 
When such is the case: Have him sit near the head 
of the bed. Wrap one blanket round his shoulders, 
and the other round his legs — having first put stock- 
ings and slippers on him. Place a sufficient number of 
pillows at his back to form a comfortable support. 
Pass bandages around them at both ends, and tie 
them firmly, first, at the edge of the pillows and then 
to the side of the bed on which he is sitting. If the 
bed is so high that his feet cannot rest on the floor, 
make loops of the free ends of the bandages, and tie 
them to the bed so that they will form stirrups. 

If he is unable to sit up, draw him well over to the 



Aspiration Aseptic Precaution 297 

side of the bed, protect his shoulders and back with a 
blanket, and fold the bed-clothes down below the ab- 
domen, covering them with one of the rubbers. 

Aspiration of the Thorax. — An accumulation of 
excess of liquid in the thoracic cavity complicates 
several diseases. The most common are: pleurisy, 
various forms of heart disease, and pneumonia. In 
pleurisy, this excessive liquid is due to increased ex- 
udation or secretion by the cells of the pleura. In 
heart disease, it is generally due to transudation of 
serum, etc., through the blood-vessels, this transuda- 
tion having been rendered possible, either by the dis- 
eased condition of the blood-vessels, or by stasis in 
the same, due to poverty of circulation. This latter 
condition is known as hydrothorax. 

The sterile requisites for aspiration of the thorax 
are: 

1. The aspirating apparatus. This consists of a 
graduated glass bottle with a rubber stopper, in which 
there is a hollow metallic tube with two branches at 
at the top ; two rubber tubes with metallic ends which 
fit the branches of the metallic tube in the stopper; 
an exhaust pump 1 ; a needle, or canula and trocar, 
the former being now most frequently used.. 

2. A hypodermic syringe loaded w T ith cocaine, 2 C [ . 

3. Glasses containing the usual disinfectants em- 
ployed for disinfecting the skin for minor operations. 

_,.. Twelve gauze sponges. 

5. Two towels. 

6. Collodion and brush, if the puncture is to be 
protected with collodion after the operation; other- 
wise, gauze dressing and adhesive plaster. 

• See Chapter XIX. 



298 Practical Nursing 

7. A solution basin containing sterile water for 
the testing of the apparatus. 
The unsterile requisites are : 

1. Stimulants. 

2 . A dressing rubber. 

3. A kidney basin. 

4. A tray. 

5. A small blanket, or nightingale, to protect that 
point of the chest not to be exposed. 

After collecting all the requisites and sterilising 
those required to be sterile, disinfect your hands, put 
the cork in the bottle, attach the two pieces of rubber 
tubing to the metal tubes in the cork and test the ap- 
paratus to make sure that it is in working order. The 
majority of exhaust pumps used for the purpose of 
exhausting the air in the bottle have two projections. 
On each of these points there is an arrow and each 
arrow points in an opposite direction. Insert the 
projection on which the arrow points upward into one 
of the pieces of tubing and then proceed as follows: 
Open the stop-cock in the metal tubing, on the side 
to which the pump has been attached, and close the 
one on the opposite end. Exhaust the air in the bot- 
tle by pumping until the pump grows hard to work. 1 
Put the end of the other tubing (in which the needle 
is to be inserted, when ready for use) into the sterile 
water and reverse the order of the stop-cocks. If the 
apparatus is in working order, the water will immedi- 
ately start to flow through the tubing into the bottle. 
Do not attach the needle until the doctor is ready to 



1 It must be remembered that the air pumped out will not 
be sterile. The pump must, therefore, be pointed away from 
the table, 



Aspirations — Aseptic Precautions 299 

use it. The preparation of the skin is the same as in 
paracentesis. 

Aspiration of the Pericardium. — In certain 
forms of heart disease, liquid sometimes collects 
under the pericardium. An exploring syringe is fre- 
quently used for removing this fluid, in preference 
to the regular aspirating apparatus. The exploring 
syringe resembles a very large hypodermic syringe. 

The sterile requisites, when the exploring syringe 
is used are : 

1. The syringe and needles, or small trocar and 
canula. 

2. Twelve gauze sponges. 

3. Two towels. 

4. The usual disinfectants, for cleansing the point 
of puncture. 

5. A hypodermic syringe, loaded with cocaine. 

6. Collodion and brush. 

A test-tube or glass to receive the fluid drawn from 
the cavity. 

The unsterile requisites are the same as for an 
aspiration. 

It is not, as a rule, necessary to shave the point of 
puncture. Otherwise the local preparation is the 
same as for paracentesis. 

Exploration. — The exploring needle is often in- 
serted to ascertain if liquid is present, before resort- 
ing to aspiration. The requisites will be the same 
as for aspiration of the pericard'um. 

Lumbar Puncture. — Lumbar puncture is per- 
formed to relieve pressure on the spinal cord, by re- 
moving an excess of liquid collected in the spinal canal. 
Such an excess is the result of some cerebral disturb- 
ance, particularly meningitis. The requisites for 



3oo Practical Nursing 

this operation are the same as for aspiration of the 
pericardium, except that a syringe is seldom required. 

Phlebotomy. — Phlebotomy, or venesection, is the 
taking of blood from a vein. It is performed either 
to relieve arterial or venous engorgement, or to re- 
move toxic blood from the body — as in gas and 
uraemic poisoning. In the latter case, the phlebotomy 
is generally followed by an intravenous infusion. 

The instruments required for phlebotomy are : 

Aneurism needle, i. 

Artery clamps, 2. 

Forceps, 11. 

Probe, 1. 

Scissors, 1. 

Scalpel, 1. 

Needles, 11. 

Sterile sponges, 11. 

Sterile towels, 11. 

Catgut. 

Black silk. 

Kidney basin, 1. 

Dressing rubber, 1. 

Usual solutions for disinfection of skin. 

8 oz. sterile graduate glass for reception of blood. 

Solution basin of sterile salt solution. 

Hypodermoclysis and Intravenous Infusions 

It has been proven by experiments on animals, and 
by clinical experience, that normal salt solution is 
quite as efficacious as blood in supplying volume to, 
and restoring a failing circulation. It is therefore 
injected after a haemorrhage to replace the lost blood, 
and, in cases of cardiac insufficiency, to stimulate the 



Infusions — Aseptic Precautions 3 OT 

heart's action. This stimulation is not due to any 
strengthening virtue on the part of the salt solution, 
but to a purely mechanical stimulus caused by the 
presence of the extra liquid necessitating stronger 
contraction on the part of the heart. Normal salt 
solution 1 is used instead of another solution only be- 
cause it can easily be rendered sterile, and is of the 
same alkalinity as the blood. Infusions are also given 
to wash from the body impurities circulating in the 
blood and to flush the kidneys. Hypodermoclysis is 
given in preference to the intravenous infusions 
when an instantaneous effect is not required. 
It is an easier and less dangerous operation, and is 
not liable to be followed by the reactionary chill, 
which is often the result of the intravenous infusion. 

Hypodermoclysis. — In hypodermoclysis, the solu- 
tion is introduced into the cellular tissue. The usual 
situations for the injection are just below the 
breasts, the anterior and lateral portions of the 
abdomen, and the external surfaces of the thighs. 

As a rule, a double current is obtained by inserting 
two needles one on each side the body. In this case, 
the necessary requisites are : 

Two aspirating needles with wires, or, if it is desired 
to have the fluid enter the tissue slowly, hypodermic 
needles. 

One piece of rubber tubing forty inches long and 
two pieces twelve inches long. 2 

One tube carrier. 3 

1 See Chapter II. 

2 When only one needle is to be used the T-connecting tube 
and pieces of rubber tubing will not be needed, the needle be- 
ing inserted in the main tubing. 

3 A hollow semicircle of steel which fits over the flask. Its 



302 Practical Nursing 

One glass connecting tube. This is inserted in the 
end of the tubing which is put into the bottle to weight 
it. 

One glass T-shaped connecting tube to join the 
three pieces of tubing. 

Two flasks of hot salt solution 115:120, and one 
flask of cold salt solution. 1 

One glass thermometer. 

One glass syringe. 

Twelve gauze sponges. 

Eleven sterile towels. 

Usual disinfectants for cleansing the patient's skin. 

One hypodermic syringe loaded with cocaine. 

One kidney basin. 

For hypodermoclysis, prepare the point of puncture 
in the usual way, shaving if necessary. 

Preparation of apparatus: Insert the stem of the 
T tube in the long piece of rubber tubing and each 
arm in a short piece. Fit the glass tube intended to 
act as a weight in the free end of the long tube, and a 
needle in each of the short pieces. Slip the end of the 
tubing which is to go into the flask into the carrier at 
the point where it will go over the rim of the flask, 
arranging it so the tip just escapes its bottom. Do 
not put the tubing into the flask until the doctor is 
ready to use it ; he then generally does so himself, and 

purpose is to prevent the tubing from slipping or becoming 
flexed on the edge of the flask. The carrier is indispensable 
if the solution is to be siphoned from the flask. In an emer- 
gency, a piece of tin or other metal can easily be bent to the 
required shape. 

1 An irrigator or douche bag can be used instead of the above 
apparatus; but the latter is to be preferred, as the solution 
is siphoned directly from the vessel in which it was sterilised, 
thus with it, lessening the danger of infection. 



Infusions — Aseptic Precautions 303 

starts the liquid flowing, either by expressing the air 
by drawing the tubing between his fingers, or by suc- 
tion obtained by disconnecting the main tubing from 
the T, inserting the nozzle of the syringe in it and 
slowly drawing up the piston, when the flow is started. 
Then reconnect the tubing and allow the fluid to flow 
through the needles to expel all air, after which he 
inserts them in the tissue. 

Intravenous Infusion. — The requisites for in- 
travenous infusion are : 

Aneurism needle, i. 

Artery clamps, 1 1 . 

Canulas with wires (different sizes), 2. 

Rubber tubing, 1. 

Tube carrier, 1. 

Forceps (mouse tooth), 1. 

Forceps ( thumb), 1. 

Glass thermometer, 1. 

Probe, 1. 

Glass syringe, 1. 

Scissors. 1. 

Scalpel, 1. 

Needles (surgeon's), 11. 

Towels, 12. 

Catgut. 

Black silk. 

Bandages. 

Sterile gauze compress, 1. 

Sterile sponges, 12. 

The usual requisites for cleansing the patient's skin. 

Kidney basin. 

Dressing rubber. 

Hypodermic syringe loaded with cocaine, 2%. 

Two flasks of hot salt solution, 1 20 F. 



304 Practical Nursing 

One flask of cold salt solution. 

In intravenous infusion, as the name implies, the 
solution is injected into a vein, one of those at the 
elbow being most frequently chosen. A bandage is 
tied tightly around the upper part of the arm, before 
the beginning of the operation, to further the engorge- 
ment of the vein. This is cut after the canula has 
been inserted in the vein. 

As the entrance of any air into the vein might kill 
the patient, it is imperative to watch that the tubing 
does not float above the solution and that it is clamped 
before the solution becomes too low in the flask. 

Injection of Antitoxine and Vaccination 

Very few discoveries in medicine have been of more 
benefit to the human race than that of antitoxine. 
Since vaccination w T as taught by Jenner, in 1796, 
small-pox has never again been the scourge it was 
previously, when whole villages were swept away by 
its visitation. The use of diphtheria-antitoxine has 
lessened the mortality from that disease more than 
60 %. Better still, it renders those exposed immune, 
so that even children who have been in direct contact 
with a patient will, if given antitoxine promptly, be 
free from danger. 

Antitoxine is not, as is often supposed, a culture of 
the diphtheria germs themselves, but a chemical pro- 
duct developed in the blood of an animal by the action 
of such cultures. 

Thus, diphtheria antitoxine is obtained by inocu- 
lating a young horse with media in which a culture 
taken from the throat of a patient suffering with diph- 
theria has been planted. The horse will have all the 



Intubation — Aseptic Precautions 305 

constitutional symptoms of diphtheria. Upon his 
recovery, he is once more inoculated. This process 
is continued for nearly a year, at the end of which 
time about 6000 cubic centimetres of blood are drawn 
from the external jugular vein. This is allowed to clot, 
and the resulting serum is the antitoxine. 

Erysipelas and streptococci serum are prepared in 
much the same way as the serum of diphtheria; also 
vaccine, except that for the latter, calves are inocu- 
lated instead of horses. The greatest asepsis is prac- 
tised in the preparation of the antitoxines, and must 
be continued in their inoculation. 

The antitoxines, with the exception of vaccine, are 
injected hypodermatically. The syringes used are like 
the ordinary hypodermic syringe, but larger. The 
syringes and their needles should be sterilised either 
by boiling, or by washing thoroughly with alcohol 
80%. The patient's skin should be prepared by wash- 
ing with green soap and a disinfectant, and the point 
of inoculation should be protected with a collodion or 
other sterile dressing. 

The method of applying vaccine depends upon the 
preparation used. Usually, the skin is scarified with 
a sterile sewing-needle, and the vaccine rubbed in. 
Everything used for the operation must be sterile, 
and the patient's skin must be cleansed and disin- 
fected in the usual manner. Septic arms always come 
either from some break in asepsis or impure vaccine. 

Intubation 

Except when the trouble is so deeply seated that 
the intubation tube will not avail, intubation has 
almost entirely superseded tracheotomy. It is per- 



306 Practical Nursing 

formed when there is danger of asphyxia from inflam- 
matory affections of the larynx or trachea, or from 
stenosis of the larynx. The instruments rendering 
this procedure possible were invented by the late Dr. 
O'Dwyer of New York. 

As it is sometimes necessary, in the absence of the 
doctor, for the nurse to perform the intubation, and 
as her knowing how to help the doctor is of much 
importance, the procedure will be explained here. 

The instruments required are : 

A mouth gag to keep the patient's jaws apart during 
the operation. 

The introducer. 

The extractor. 
. The tubes. 

All intubation sets contain several tubes of graded 
size. Those for children are numbered, and the num- 
ber chosen should be the one agreeing approximately 
with the child's age. A loop, some eight inches long, 
of heavy silk thread, is tied through the perforation 
in the neck of the tube. Inside the tube is a piece of 
metal called the obturator, and, to this, the introducer 
is attached while inserting the tube. 

The usual office of the nurse is to hold the patient, 
keeping him perfectly quiet, and in such a position 
that the mouth and trachea will be perfectly straight. 
Failure to do this results in loss of time, and in such 
cases there is seldom a second to lose. If the patient 
is a child, you will do best, as a rule, to hold him sitting 
in your lap. Secure his extremities by rolling him in 
a blanket, grasp his arms through the blanket, just 
above the elbow, rest his head against your shoulder., 
and sit so that the light will fall directly upon his 
mouth, keeping it open with the mouth gag. If the 



Intubation — Aseptic Precautions 307 

doctor is able to have a second assistant, it is generally 
this second assistant who holds the mouth gag and 
steadies the child's head. In inserting the tube, the 
operator sits facing the patient. He introduces the 
index finger of his left hand — protected with adhesive 
plaster, or a metal cot — into the mouth, holding down 
the tongue with it and lifting up the epiglottis. After 
seeing that the silk loop is free, he passes the intro- 
ducer, connected with the obturator in the tube, into 
the mouth alongside his finger, slips the tube into 
the trachea, and presses it into position with the 
index finger of his left hand. He then immediately 
removes the obturator. If the tube is in the trachea, 
the breathing will be much improved, as soon as the 
first gush of mucous discharge — caused by the violent 
respiratory effort that takes place upon the introduc- 
tion of the tube — is over. If it has been put into the 
oesophagus, no improvement will take place. It is 
partly to avoid accidents from this mistake that the 
silk thread is attached to the tube, as it can thus be 
easily pulled out. This thread is sometimes left at- 
tached to the tube, as long as the latter remains in the 
pharynx; but, as a rule, it is pulled out as soon as the 
tube is securely in place, the tube being removed, 
wdien required, with the extractor. The chief objec- 
tion to leaving the thread is that the patient, unless 
his hands are continually tied, is likely to pull the tube 
out at any time by pulling the thread. Before remov- 
ing the thread, cut off the knot, otherwise, if the wrong 
end is drawn through the tube, the knot coming to the 
hole will displace the tube. When the thread is 
left on, fasten it over the ear, and secure it further by 
putting a strip of adhesive plaster over it, across the 
cheek. 



308 Practical Nursing 

Taking Throat Cultures 

To take a throat culture: Place the patient in a 
good light. Rub any exudation or patch with a ster- 
ile cotton swab taken from a sterile tube. Remove 
the cotton plug from the culture tube, being careful 
that it never comes in contact with anything unsterile, 
since the culture would be rendered valueless by the 
introduction of outside germs. Insert the swab, rub 
it gently but freely over the surface of the media 
therein and reinsert the cotton plug. Replace the 
swab in its own tube and plug it carefully. It must 
not come in contact with anything but the patient's 
throat. If it does so before touching his throat, the 
culture will not be pure, and if it does so afterward, 
and the patient has diphtheria, whatever it touches 
will be infected. 

The Blood 

The blood is a body fluid which circulates through 
the arteries, capillaries, and veins of the blood supply- 
ing food and oxygen to the tissues and carrying from 
them carbon dioxide and other waste products to the 
excretory organs. It is composed of cells which 
float in a fluid medium, the plasma. The weight of 
the blood is about one-thirteenth of the weight of the 
body. 

The plasma is an almost colourless fluid composed of 
about 90% of water and 10% of organic compounds 
and salts. The 'organic compounds are both 
nutritious and excrementitious ; the former being 
chiefly proteids with a small amount of fats and glu- 
cose, the latter being products which are the result of 
tissue activity, such as urea, the urates, etc. 



The Blood — Aseptic Precautions 3°9 

An important proteid of the plasma is fibrinogen, 
a substance which becomes fibrin when blood is shed. 
Fibrin exists as a fine mesh-work which catches and 
holds the blood cells, forming the clot. The fluid part 
of the plasma which remains after fibrin has formed is 
known as the blood serum. It has no power to clot. 
Serum, therefore, is plasma minus fibrinogen and blood 
cells. 

The blood cells, or corpuscles, are of two kinds: the 
white blood cells, or leucocytes, and the red blood cells. 

The white blood cells are colourless, have a nucleus, 
and are about one to two times larger than the red 
blood cells. They are formed in the lymph nodes and 
bone marrow, and their functions are to remove for- 
eign material such as bacteria, and to assist in the 
repair of tissue, as in the formation of scars. Their 
number varies between 3000 and 10,000 to the cubic 
millimetre of blood. 

There are various types of white blood cells differ- 
entiated by staining them with dyes in smears made on 
glass slides. Each type has a structure different from 
the others and a different reaction to the dye. 

The chief types of these in diagnostic value are the 
lymphocytes (22-25% °f the ^ T hite cells), the polynu- 
clear leucocytes (65 to 75%), the eosinophils (2-4%), 
and the myelocytes. The latter are not found in 
normal blood, but are present in myelogenous 
leukaemia and in some forms of severe anaemia. 

The red blood cells number about 5,000,000 to the 
cubic millimetre of blood. They are smaller than the 
white blood cells and have no nucleus. They contain 
the colouring matter of the blood, haemoglobin. This 
substance is a proteid containing iron and has the 
property of combining with oxygen from the air taken 



3io Practical Nursing 

into the lungs, and carrying it to the tissues where it 
is given up to them. Haemoglobin is measured by 
4 'per cent.," 100% being taken as the average amount 
in a normal healthy individual. The red cells are 
derived from the bone marrow, liver and spleen. Their 
function is to carry oxygen to the tissues. 

The Blood in Disease 

It has been found that the composition of the blood 
is altered in disease, and these changes have Joeen 
made use of for diagnostic purposes. The changes 
may be (i) in the number of white cells, (2) in the 
relative proportion of the various types of white cells 
to each other, (3) in the number of red cells, or (4) in 
the amount of haemoglobin. 

(1) The white blood cells, or leucocytes, may be 
either decreased or increased in number. (The cubic 
millimetre of blood is the unit in which blood cells are 
numbered.) A decrease in leucocytes is known as 
leukopenia. It occurs sometimes in typhoid fever, 
malaria ; and in some forms of anaemia. 

An increase in the leucocytes over the normal limit 
of 10,000 to the cubic millimetre is known as leucocy- 
tosis. Leucocytosis occurs in many of the infectious 
diseases, chiefly: scarlet fever, diphtheria, pneumonia, 
rheumatic fever, erysipelas, and suppurative conditions 
generally such as appendicitis, peritonitis, abscesses^ 
etc. In typhoid fever, tuberculosis, measles, malaria, 
and mumps there is no leucocytosis. Leucocytosis 
also follows the administration of chloroform, ether, 
the injection of tuberculin, saline infusions, cold baths, 
and the inhalation of illuminating gas. 

(2) Changes in the relative proportion of the differ- 
ent types of white cells to each other are estimated by 



The Blood — Aseptic Precautions 3 11 

counting several hundred cells in stained smears and 
noting the number of cells of each type as the count 
is made. This is known as a differential count. 

The polynuclear leucocytes are found to be most 
commonly relatively increased in those diseases and 
conditions causing leucocytosis, and it is the increase 
in this type that causes the leucocytosis. 

An increase in the lymphocytes is known as lympho- 
cytosis, and is seen only in leukaemia. This increase 
may be great enough to make the total count of white 
cells reach 100,000 to 200,000 to the cubic millimetre 
of blood. A slight relative increase in lymphocytes 
sometimes occurs in typhoid fever. 

The eosinophiles are found to be relatively increased 
in bronchial asthma, when intestinal parasites are 
present, and most markedly in trichinosis where they 
may reach 60% of the white blood cells. 

(3)and(4). Changes in the number of red cells and 
in the amount of haemoglobin occur together, because 
the haemoglobin is contained in the red cells, but the 
change in one element may be greater than the change 
in the other. Increase in these elements is not com- 
mon but occurs in chronic cyanosis. Decrease is 
much more common and the condition produced is 
known as anaemia. 

The Estimation of Haemoglobin 

The percentage of haemoglobin in the blood may be 
estimated by a number of methods. The one gener- 
ally used in hospital wards is known as the Tallquist 
method. It is a rough but fairly accurate test and 
consists in the comparison of a piece of blood-stained 
filter-paper with a lithographic plate representing 



3i2 Practical Nursing 

the colours of ten solutions of haemoglobin ranging 
from ten to one hundred per cent. 

This scale and sheets of good quality filter-paper 
are put up in book forms. A small piece of the filter- 
paper is touched to a drop of blood and as soon as 
this diffuses through the paper, the stain is compared 
with the scale. 

The estimation of haemoglobin is made also with 
various instruments, viz., the haemoglobinometers of 
Gower, Fleischl, Dare, etc. 

Blood Smears 

"Smears" for the microscopical examination of 
blood cells are made on glass slides or cover-glasses, 
which before using must be thoroughly cleansed. 

If slides are used a drop of blood taken from the lobe 
of the ear or the finger tip with the usual aseptic pre- 
cautions is lightly scraped off with the smooth end of 
a slide and pressed gently upon the flat surface of 
another slide, which is laid upon a table or other firm 
support. When the blood has spread along the edge 
the first slide should be held firmly, but with light 
pressure, at an angle of about 30 , and drawn slowly 
along the receiving slide, thus spreading the blood 
evenly over the surface. 

If the cover-glass method is used, a cover-glass is 
touched to the drop of blood and applied to a second 
cover-glass with the corners projecting. The blood 
will spread between the two surfaces and then the 
cover-glasses should be gently drawn apart. Forceps 
should be used in handling the glasses to prevent mois- 
ture of the fingers from affecting the smear. 

Smears should be well dried in the air and fixed by 



The Blood — Aseptic Precautions 3 1 3 

passing through the flame of a Bunsen burner. As 
a rule they are then stained, after which they are ready 
for examination under the microscope. 

Blood Cultures 

These are made for the purpose of demonstrating 
bacteria which may be present in the blood. They 
are of value in determining for diagnostic purposes 
the specific organism which is the exciting cause of an 
infectious disease, or for the purpose of preparing vac- 
cines or antitoxines from that organism for the treat- 
ment of that disease. 

Bacteria are found in the blood in some cases of 
typhoid fever, pneumonia, malignant endocarditis, 
and septicaemia. The culturing of the bacteria in 
these cases, the preparation of vaccines, etc., are the 
work of the bacteriologist and cannot be considered 
here. 

About ioc.c. of blood is the quantity required, and 
it is obtained in the following manner: the blood is 
usually taken from one of the prominent veins of the 
forearm. A ligature is applied to the upper arm tight 
enough to prevent the return flow of venous blood, 
but not to interfere with the flow of blood through the 
artery, that is, tight enough to cause cyanosis of the 
hand without obliterating the radial pulse. This will 
distend the vein. The skin over it is then thoroughly 
cleaned with green soap, alcohol, ether, and bichloride 
in succession. A hollow needle is connected to one 
end of a glass tube, and the needle is plunged through 
the skin into the lumen of the vein. If the vein is 
well distended, the pressure in it is great enough to 
force the required amount of blood through the needle 



314 Practical Nursing 

into the tube. The blood obtained is then distributed 
through a series of tubes containing the culture media 
and these are sent to the bacteriologist. 

The whole procedure must be done under thor- 
oughly aseptic conditions, the operator preparing his 
hands as for a surgical operation. The tube and 
needle are previously sterilised by dry heat. If the 
patient is delirious or very nervous, it may be of 
assistance to bind the arm to a basswood splint of 
sufficient length to extend under the body, before 
beginning the procedure. 



CHAPTER XXI 

CARE OF PATIENT BEFORE AND AFTER OPERATION 

Preparation of Patient for Operation. Care after 
Operation. 

Preparation of Patient for Operation 

Bath. — To avoid tiring the patient on the day of 
operation, the bath is generally given the preceding 
day. It must be very thorough and should include 
the washing of the hair, unless this has been done very 
recently or the patient is too weak to stand it. 

Bladder. — Always see that the patient voids urine 
shortly before operation. The sphincter muscles 
relax under the influence of anaesthetics and any urine 
left in the bladder is likely to be voided during the 
operation. Before abdominal section, many surgeons 
require the patient to be catheterised, as there is dan- 
ger of cutting into the bladder, if it is in the slightest 
degree distended. 

Catharsis. — The bowels should be very thoroughly 
emptied before operation. If they are distended 
all the faecal matter they contain is likely to be evac- 
uated, when the sphincter muscle is relaxed and 
there is also danger of an accidental incision. Fur- 
thermore, the chances of nausea are much less, if the 
system is well cleaned out before the anaesthetic is 
taken. 

315 



316 Practical Nursing 

A strong cathartic is usually given the morning 
or afternoon of the day before the operation, and a 
second one, if there is no result before night. An 
enema is given about six hours before the operation 
and is repeated if the intestine does not seem well 
emptied. 

Diet. — To lessen the danger of nausea and the pres- 
ence of much residue in the intestine, only light, easily 
digested food is given the day before operation, 
and no solids after the evening meal. Liquids, with- 
out milk, are generally allowed until six hours before 
operation. From then on, unless the patient's condi- 
tion requires it, nothing but water is given, and only 
a small quantity of that. 

Local Preparation. — To prepare the field of oper- 
ation, shave it and the surrounding skin and scrub 
for five minutes with green soap, using sterile water 
and sterile cotton ball. The rest of the preparation 
varies greatly in different hospitals. In some, noth- 
ing more is done until the patient is on the operating 
table. In others, the preparation begins about four 
hours before the time of operation and the scrubbing 
with soap is followed by a scrubbing with Harrington's 
solution 1 or other disinfectant and the application 
of a green soap poultice 2 20%. This poultice is 
covered with rubber tissue and held in place with a 
gauze binder and is left on until the patient is on the 
operating table. Another method is to make this or 



Alcohol 640 c.c. 

Muriatic acid 60 

Harrington s solution ^ Corrosive sublimate 8 gm. 

Water 300 c.c. 

Carmine 2 gr. 

2 A dressing towel or gauze compress saturated with soap 
solution. 



Care of Patient 3 l 7 

some like preparation the afternoon of the day pre- 
vious to the operation, and, when the green soap poul- 
tice has been on for four hours, to replace it with a 
gauze pad wet in bichloride or other disinfectant. This 
method was formerly a very common one; but, as it 
causes the patient considerable discomfort and is 
frequently followed by an eczema of the skin, it is 
becoming much less so, especially as the results attend- 
ing the shorter preparations have been quite as 
satisfactory. 

In all cases, the scrubbing is repeated when the pa- 
tient is on the operating table. Alcohol, benzoin, and 
Harrington's solution are the disinfectants then most 
commonly used, as they all have cleansing as well as 
disinfectant properties. 

Vaginal Operations. — A green soap douche is 
generally given some hours before a vaginal operation, 
and this douche is followed by one or more douches 
containing such disinfectants as lysol \% or solution of 
carbolic i : 120. After the douche the mlva should be 
covered with a sterile pad held in place by a T binder. 

The local cleansing for vaginal operations is seldom 
done until the patient is on the operating table and 
under the influence of the anaesthetic. 

A common formula is: Wash — using a sterile gauze 
sponge, on a sterile clamp — with (1) green soap, (2) 
sterile water, (3) bichloride of mercury 1-1000, (4) 
sterile water. 

Final General Preparation. — Shortly before the 
patient leaves the ward, make sure that he has no false 
teeth, put on him a clean nightgown and laparotomy 
stockings, and, in the case of a woman, braid the hair 
in two braids and tie it securely under a cap of 
muslin or gauze. 



3 18 Practical Nursing 

Preparation for Minor Operations. — For minor 
operations, when no ether is given, local preparation 
is, as a rule, all that is necessary. The common 
methods are : 

i. Wash with (a) green soap, (b) sterile water, (c) 
ether, (d) alcohol (e) bichloride of mercury i-iooo. 

2. Wash with (a) green soap, (b) Harrington's 
solution, (c) sterile water. 

3. Wash with (a) green soap, (6) alcohol 80%. 
Before starting the local preparations, the nurse 

should wash and disinfect her own hands. Every- 
thing used in the process should be sterile. 

Care of Patient after Operation 

After an operation of any extent, there is more or 
less shock. Therefore the bed and blankets must be 
warmed (see Chapter V ). The hot- water bags are 
seldom left in the bed, however, unless the patient is 
in bad condition, since burns easily occur, owing to 
the depressing effects of the anaesthetic, and the con- 
sequent sluggishness of the superficial circulation. 
When it is necessary to have heaters or hot- water bags 
in the bed, they must be very carefully covered, and 
watched, and the nurse in charge of the case must not 
go off duty without informing her successor of their 
presence. 

A patient should never be left alone while coming 
out of ether. There is always danger of his becoming 
restless, of the tongue falling back over the trachea, or 
of vomitus getting into the trachea. While he is vom- 
iting, keep his head turned on one side, with your 
fingers behind the angle of his jaw, throwing it for- 
ward, and pressed against the root of his tongue to 
prevent the tongue from falling backward. 



Care of Patient 3^ 

After abdominal section, 1 to avoid strain on the 
stitches, place your hands on either side of the wound 
while the patient is vomiting. 

No matter how slight the operation, be on the watch 
for symptoms of h morrhage (see Chapter VII). Do 
everything possible to make an operative case com- 
fortable, so that the patient will remain quiet, for 
restlessness increases the strain on the sutures and 
the danger of haemorrhage. 

Owing to the drying up of the mucous membrane 
by the anaesthetic, patients generally suffer intensely 
from thirst for some hours after an operation. It is 
impossible to give much to drink, as it would cause 
nausea, but much relief can be given by washing the 
mouth frequently with some lubricating mouth wash, 
such as 3 i of albolene and lemon juice, to oz. i boric 
acid solution 2%. When water is allowed, give it, 
at first, in drachm doses and either hot or very cold. 
Tepid water will increase nausea. 

When crushed ice is ordered for nausea, crush it 
very fine so that it can be swallowed as ice immedi- 
ately. To prevent the ice from melting quickly, drain 
off the water by tying a piece of gauze over the mouth 
of a tumbler, placing the ice on the gauze. 

As anaesthetics frequently affect the kidneys, the 
urine should be measured and its quality noted, until 
it is normal in every respect. If the patient does not 
void urine within twelve hours after operation, 
the fact should be reported. 

1 Abdominal section is also known as " laparotomy" or 
"cceliotomy." These terms include all operations in which 
incision is made into the peritoneum, 



CHAPTER XXII 

OPERATING-ROOM TECHNIQUE, ETC. 

Care of the Operating Room. Temperature of the Oper- 
ating Room. Care of the Patient During Operation. Dis- 
infection of the Hands. Preparation of Dressings, Ligatures, 
etc. Preparation for Operation in a Private House. List 
of Principal Operations. 

IN newly severed tissue, there is the greatest possi- 
ble danger of infection; therefore, the strictest 
asepsis must be maintained, not only during the time 
of operation, but in the minutest detail of the pre- 
paration of everything that may come directly or 
indirectly in contact with the wound. 

Care of the Operating Room 

Not only must all dust be removed from every part 
of the operating room, but, as far as possible, it must 
be prevented from entering. All windows that open 
connecting directly, or indirectly, with the operating 
room, must be screened with fine wire, and the screens 
covered with two thicknesses of gauze, which should 
be frequently changed. Ventilators intended for the 
admission of air should be likewise covered. The 
floors and walls of the operating room are usually of 
a substance which can be washed. The floor should 
be scrubbed daily or flushed down with a hose, and the 
walls, at least to the height of seven feet, should be 

21 ^20 



Operating-Room Technique, Etc. 321 

washed weekly. This method of removing dust re- 
places sweeping, which only distributes the dust 
through the air whence it may fall on sterile articles 
and into the wound. 

Between operations, the floor should be mopped 
with a disinfectant. The mop used must be kept ex- 
clusively for this purpose, and, when not in use, should 
stand in a disinfectant. 1 

The furniture and utensils of the operating room 
are chiefly of iron, glass, and agate. They are neces- 
sarily very expensive, and the utmost care must be 
exercised in handling them. They must not only be 
thoroughly scoured, but all stains caused by disinfect- 
ants, etc., removed. Everything should look not only 
clean, but "shining." 

There must be an exact place for everything. Every- 
thing must always be returned to its proper place and 
every one connected with the operating-room work 
should know where that place is. 

Temperature of the Operating Room 

During operations, the temperature of the operating 
room should be kept between 74 and 80 ° F. Pneu- 
monia is a frequent sequel of operations. In the ma- 
jority of such pneumonia cases, the irritating effect 
bf the ether is considered the predisposing cause, but 
it is frequently attributed to the chilling of the body 
while under the influence of the anaesthetic. Cold 
is very easily taken at such times, the skin circulation 
being poor, and the vitality low. Another reason 
for a hot room is that the patient is less liable to suffer 
from shock when kept in warm surroundings. 

1 A weak solution of chloride of lime is a good disinfectant 
to use for this purpose. 



322 Practical Nursing 

Care of the Patient During Operation 

Before administering an anaesthetic, make sure that 
the patient has no false teeth, and see that the neck 
of the nightgown is unbuttoned. Four points to be 
remembered in connection with the placing of the 
patient on the table are : 

i. That 'there should be no exposure while getting 
him in position. 

2. That his body should be well wrapped in 
blankets. 

3. That hot- water bags should be well secured in 
heavy covers, if he is in such bad condition that hot- 
water bags are necessary. 

4. That his arms should be so placed that they will 
not hang over the edge of the table. To this end in 
all operations except those on the chest, turn the tail 
of the nightgown up over the arms, cover arms and 
chest with a blanket and tuck it firmly in so that it will 
hold the arms in place. In chest operations, extend 
the arms above the head and see that they are well 
covered. 

When the patient has thus been properly placed, 
upon the table, cover the blankets in which he is 
wrapped with a rubber and this, after the field of 
operation has been scrubbed, with a sterile fenes- 
trated sheet, the opening of which must include the 
seat of operation. Place sterile towels around this 
opening, changing them or covering them with fresh 
towels as they become stained during the operation. 
Sufficient towels should be used to keep everything 
sterile, but there must be no unnecessary extrava- 
gance. As stimulation may be needed at any moment 
stimulants, a sterile hypodermic syringe, and appa- 



Operating-Room Technique, Etc. 3 2 3 

ratus for giving rectal stimulation must be near at 
hand. 

The nurse in charge of the operating-room is respon- 
sible for the conduct of all operations. She must 
account for everything given to the sponge nurse — 
sponges, pads, packing, etc. She must be watchful 
that no one makes a break in aseptic technique ; that 
hand and sponge solutions are changed when neces- 
sary; and that cautery, irrigations, dressings, etc., 
are at hand when needed. 

The sponge nurse is not only responsible for hand- 
ling sponges quickly and deftly, but she must also 
keep track of the sponges, pads, etc., given into her 
charge. She should know their exact whereabouts, 
and, at any moment, be able to account for every one 
of them. Many a wound has had to be opened be- 
cause a sponge or a pad was left in the cavity. 

The quicker the operation is performed, the better 
the patient's condition is likely to be afterward. Some- 
times, it is of vital importance that the patient be kept 
under the influence of the anaesthetic but a very 
short time. Therefore, nurses should do everything 
in their power to expedite matters. When preparing 
for an operation, do not forget anything likely to be 
required. During an operation observe what is re- 
quired, without having to be asked for it, and work 
quickly, but without any appearance of excitement 
or rush. It is fatal for a nurse to lose her head in 
emergency. 

The head nurse, in addition to her work during the 
operation, has the charge and supervision of preparing 
most of the materials employed. She must know the 
special requirements of each surgeon with whom she 
works, as well as the instruments required for each 



324 Practical Nursing 

operation. The methods of preparing the requisties 
for operation which are given below vary in different 
hospitals, but the formulas given here are very com- 
mon ones. A most important point to remember in 
their preparation is that, before touching anything 
sterile, the hands must be as carefully disinfected as 
before operation. 

Disinfection of the Hands 

To prepare the hands for disinfection : Scrub the 
hands and arms for three minutes with hot water and 
green soap, 1 using a sterile nail-brush. 2 Clean finger 
nails with a sterile orange stick. Scrub again for three 
minutes. Then, rinse with sterile water and disinfect. 
During the scrubbing process the water should be fre- 
quently changed. 

The following are some of the most common meth- 
ods of disinfecting the hands : 

1. Wash for three minutes with a lather made of 
equal parts of chloride of lime and carbonate of soda, 
rinse in sterile water and immerse in bichloride of 
mercury 1 : 100 for three minutes. 

2. Immerse the hands and arms in a solution of 
permanganate of potash ( two ounces to four quarts 
of water), then in a solution of oxalic ( eight ounces 
to four quarts of water ) and, finally, in bichloride of 
mercury 1 : 1000. 

3. Immerse the hands and arms in alcohol 50%, 
and then in permanganate and oxalic as above. 

1 Sterile sand is used in addition to the soap in many 
hospitals. 

2 Bleach new nail-brushes by soaking them in a saturated 
solution of oxalic acid for twelve hours. Boil them in 
water for ten minutes and keep them in carbolic solution 1 : 40. 
Boil for ten minutes between operations. 



Operating-Room Technique, Etc. 3 2 5 

4. Soak the hands in alcohol 1 50% for two min- 
utes, and in bichloride of mercury for three minutes. 

5. Rub with methylated spirit for three minutes 
and scrub for two minutes with a 70% sublimate 
alcohol (1 in 1000). 

Gloves are now nearly always worn during opera- 
tions, and frequently, while preparing for them. Fine 
thread ones are sometimes used. These are sterilised 
in the same manner as the dressings. For the cleans- 
ing and sterilisation of rubber gloves see Chapter XIX. 

Preparation of Dressings, Ligatures, etc. 

Dressings. — In preparing dressings, sterilise the 
gauze and absorbent cotton required for each dressing 
in individual packages, and do not open these pack- 
ages until required for use (see Chapter XIX). 

Instruments. — For the sterilisation of instruments 
see Chapter XIX. 

Adhesive Iodoform Gauze. — To prepare adhesive 
iodoform gauze, sterilise gauze, cut the required size 
and saturate immediately before using with the fol- 
lowing solution: 



Iodoform powder, 


22 grammes. 


Resin. 


10 


Glycerine, 


5 c.c. 


Alcohol, 


26 " 



Iodoform Gauze. — To prepare iodoform gauze; 
Cut fine absorbent gauze one yard square, fold it and 
sterilise for one hour. Wring the gauze through iodo- 
form solution until it is all taken up. Then, fold and 
put in sterilised glass tubes. While making this gauze 

1 Alcohol is becoming a very common disinfectant for the 
hands, as in addition to its antiseptic qualities it cleanses and 
hardens the skin. 



326 Practical Nursing 

wear sterile rubber gloves. Scrub and disinfect 
the hands and arms before putting them on and 
have everything used in the process absolutely sterile. 
For every yard of gauze, mix : 
60 c.c. salt solution. 
1 5 grams of iodoform powder. 
8 c.c. 95% carbolic acid. 
S " liquid green soap. 
Sufficient clean castile soap to make a good 
lather. ' 

Catgut Ligatures — Catgut ligatures are pur- 
chased in bundles of six to ten strands each two and 
one-half yards long. To prepare the gut for use: 
Wind on clean glass reels, half a strand on each reel. 
Place reels in an air-tight glass jar, cover them with 
ether and soak for twenty-four hours shaking the jar 
every four hours during this time. Pour off the ether 
and immerse the reels in a 1 : 500 alcoholic solution of 
bichloride of mercury, made with 95% alcohol letting 
it stand, for one hour. Pour this off, cover the reels 
with 95% alcohol, and place the jar in a bath, allowing 
the alcohol to boil for ten minutes. The gut will then 
be ready for storage. Before use, boil again for ten 
minutes in the same manner. 

Chromicised Catgut Ligatures. — To prepare 
chromicised catgut ligatures; Wind the gut on reels. 
Place it in 95% alcohol for twenty- four hours and 
allow it to dry by spreading between sterile towels. 
Place it in chromic solution 1 and leave it for twenty- 
four hours to three days. At the end of this time, 

1 Chromicising solution : 

Bicarbonate of Potassium, gr. lxxv. 
5% sol. carbolic, pts. v. 



Operating- Room Technique, Etc. 3 2 7 

remove it, 1 and dry slightly. Then, let it stand six 
days in a i : 5000 alcoholic solution of bichloride of 
mercury made with 7o r c alcohol. Keep it in sterile 
jars containing 70% alcohol and boil it in a water 
bath for ten minutes before using. 

Horsehair Ligatures. — To prepare horsehair 
ligatures, put twelve strands of horsehair in each 
glass tube, plug the tube with cotton, and sterilise 
with live steam fifteen pounds pressure for one hour 
on two successive days. 

Silk-Worm Gut Ligatures. — Silk-worm gut liga- 
tures are prepared in the same manner as horsehair 
ligatures. 

Surgeons' Silk Ligatures. — Surgeons' silk comes 
in four sizes — fine, intermediate, heavy, and very 
heavy. To prepare ligatures therefrom, wind strands 
each one yard long on glass reels, place the reels in 
glass tubes, plug the tubes with cotton and sterilise 
with live steam at fifteen pounds pressure on two 
successive days. 

Gauze Pads. — Gauze pads for abdominal section 
are generally made of two thicknesses of gauze and in 
three sizes: 

Largest, 12 x 15 inches. 
Medium, 12 x 5 inches. 
Small, 12 x 3 inches. 

To make the pads : Turn in all the raw edges of the 
gauze and sew. To facilitate keeping track of these 
pads, in order that none be left in the wound, it is well 
to do them up in packages of six (or other standard 
number). Both the head nurse and the nurse who 
does up the package should count them. 

1 Keep Xos. 1 and 2 in the solution for twenty-four hours; 
three and four, three davs. 



328 Practical Nursing 

Rubber Tissue. — To prepare rubber tissue for 
use in operations, scrub it with green soap — 
using a sterile brush — wash with cold, sterile water 
and soak in bichloride of mercury i : ooo for twenty- 
four hours. Keep in sterile normal salt solution. 

Rubber Tubing for Drainage. — To prepare rub- 
ber drainage tubing for use in operations, scrub it 
with liquid green soap. Boil it for fifteen minutes 
before using. 

Gauze Sponges. — To make gauze sponges, fold 
nine-inch squares of gauze, so that all the raw edges 
will be securely held inside. 

Cotton Sponges for Washing Instruments. — 
To make a cotton sponge tie a small piece of absorbent 
cotton in a nine-inch square of gauze. 

Reef Sponges. — The average cost of reef sponges, 
unprepared, is two and one-half cents a piece. To 
prepare a reef sponge: Wash through two waters. 
Bleach in a saturated solution of permanganate of 
potash, followed by a saturated solution of oxalic 
acid. Wash through two waters. Soak for twelve 
hours in a solution of muriatic acid, 15 c.c. to 
1 litre. Wash in water until free from sand, using 
ten to twenty waters. Soak for twenty-four hours 
in a solution of bichloride of mercury 1:1000. 
Keep in a solution of carbolic 2%% until ready for 
use. 

Do not keep sponges on hand longer than two weeks. 
Burn them after use. 

Tampons. — Tampons are used both as a substitute 
for pessaries and as a medium for applying local ap- 
plications to the uterus or surrounding parts. They 
are generally made either of absorbent cotton or 
lamb's wool. 



Operating-Room Technique, Etc. 3 2 9 

To make absorbent cotton tampons: Cut strips of 
cotton one inch thick, three inches wide, and six 
inches long. Double these strips and tie them with 
strong linen thread, leaving the ends of the thread 
about six inches long. Knot these at the ends. 

To make lamb's wool tampons: Twist a piece of 
wool ten inches long and two inches wide around the 
fingers, forming a loop with both ends at the bottom. 
Tie the loop through the top with linen thread, 
leaving strings six inches long. Knot these at the 
end. 

Utensils. — For the preparation of utensils, see 
Chapter XIX. 

Preparation for Operation in a Private House 

In the choice of a room for operation in a private 
house: A good light is the first consideration, since 
this is a positive necessity. It is important also that 
the operating room should be convenient to the pa- 
tient's bedroom. To prepare the room, remove all 
rugs, carpets, draperies, curtains, knick-knacks, and 
unnecessary furniture. 

The day before operation, 1 dust down the walls of 
the room with a hair-brush covered with a duster, 2 
paying special attention to all cornices and mould- 
ings. See that the floor is scrubbed or, at least, wiped 
with a damp cloth. The floor should also be dusted 

1 When unable to start preparations the day before opera- 
tion, it is better not to disturb the pictures, etc., and not to 
dust down the walls, as by doing so the dust is disturbed, and 
all that is left behind, not having had time to "settle." will be 
in the air and ready to fall on sterile objects, or into the wound. 

2 When moisture will not injure the paper, this cloth should 
be slightly dampened. 



330 



Practical Nursing 



with a damp cloth a couple of hours before the time 
to prepare for operation. 

There will be needed: a narrow kitchen table, for 
the operating table (if it is not sufficiently long, place 
two tables together and tie their legs firmly to keep 
them from slipping apart), three small tables, and a 
chair. Choose old furniture. Protect the floor under 
and around the operating table with rubber, or sev- 
eral thicknesses of paper, and cover the rubber with 
a sheet, securing the sheet at the corners with thumb 
tacks. Protect the table intended to hold the solu- 
tions, instruments, dressings, etc., with rubber or 
paper, cover with large towels, which, pin to the 
legs of the table. Cover these later with sterile 
towels. 

Cover the operating table with a couple of folded 
blankets, protect them with rubber, and pin or tie the 
latter under the table. 

If a Kelly pad is required, one can be 
improvised by rolling a small blanket 
tightly over a stout two-inch bandage ; 
the roll should be about one yard in 
length and nine inches in circumfer- 
ence; the bandage should be long 
enough to extend half a yard beyond 
the roll at either end. Roll the 
blanket in one end of a rubber 
sheet. This rubber sheet should be the 
width of the roll and sufficiently long 
for its free end to reach into a pail 
standing on the floor. Tie the ends 
of the bandage together so that the 
roll will form an almost complete circle, pin the edges 
of the free end of the rubber together to form a 




Operating-Room Technique, Etc. 331 



drain. Oilcloth such as is used for covering shelves, 
etc., can be used instead of rubber sheeting. 

Operating gowns can be improvised with sterile 
sheets. Three common ways of doing so are : 

1. Pin, with safety-pins, two small sheets together 
at the sides to within about seven inches of the top, 
pin the top edges together, leaving sufficient space 
in the centre to pass the head through. The spaces 
at the top of each side are to put the arms through. 
Pin the ends of the sheet, which fall over the shoul- 
ders, around the arms three or four inches above the 
elbows. Do the pinning on one side before sterilising 
the sheets. An assistant should pin the other side with 
sterile pins after the sheets are in place, being careful 
not to touch the front surface. 

2. Place a sterile sheet across the front of the body 
directly under the arm-pits, be careful while unfolding 
and placing it in position not to let it touch anything 
unsterile, and only handle it with sterile hands, at the 
extreme edges. Bring the two ends over the shoul- 
ders and upper part of the arms, pin the upper edge 
of these ends together to the front of the sheet, carry 
the points under the arms and pin them so that they 
will form a short sleeve, pin the back edges of the sheet 
together at the back about the waist line. 

3. Put a sheet around the body under the arm- pits. 
Pin the two ends together at the side, and the upper 
edges over the shoulder and upper part of the arm. If 
the sheets are too long they can be turned under at 
the top. 

A stretcher can be improvised by tying the legs of 
two strong straight-legged chairs together, and then 
tying pillows or a blanket across their backs. Place 
a sheet folded in four where the buttocks will rest. 



33 2 Practical Nursing 

This will facilitate the lifting of the patient from the 
stretcher to the table or bed. When a heavy patient 
is to be lifted, one person lifts the head and shoulders, 
a second the feet, a third stands on the far side of 
the bed and grasps one end of the folded sheet, and a 
fourth stands at the side of the stretcher and grasps 
the other end of the sheet. All lift in unison. 

If the light is glaring, or if people can see in from 
outside, either rub whiting or sap olio over the win- 
dow or tack a piece of gauze across it. 

Have on hand a plentiful supply of cold sterile 
water, boiling water, and sterile towels. For meth- 
ods of sterilising towels, see Chapter II. Reliable 
sterile dressings can now be purchased at almost any 
drugstore. Gas stoves, enamel dishes, towels, etc., 
can be rented from many of the general nurses' regis- 
tries in all large cities. 

List of Principal Operations 

The principal operations are the following: 

Abscess, For, i. e. , a cavity containing pus. 

Abscess Ischiorectal, For, i. e., an abscess in the is- 
chiorectal fossa. 

Abscess Perinephritic, For, i. e., an abscess around 
the kidney. 

Adenectomy — The excision of a gland. 

Advancement — An operation to remedy strabismus. 

Alexander's Operation — Fixation of the uterus by 
shortening the round ligaments. 

Amputation — The removal of part of the body. 

Ankylosis, For, i. e., stiff joints. 

Appendectomy or Appendicectomy — Excision of 
the vermiform appendix. 

Arthritis, For, i. £., inflammation of a joint. 



Operating-Room Technique, Etc. 333 

Bursitis, For, i. e., inflammation of the bursa — a 
small sac between movable joints. 

Cellulitis, For, i. e., inflammation of the cellular 
tissue. 

Cholecystectomy — Excision of the gall-bladder. 

Cholecystorrhaphy — Suturing of the gall-bladder. 

Cholecystomy — The formation of a fistula into the 
gall-bladder. 

Cholecystotomy — Incision of the gall-bladder. 

Chololithotomy — Incision of the gall-bladder for 
removal of stone. 

Circumcision — Excision of the prepuce or foreskin 
of the penis. 

Coccygectomy — Excision of the coccyx. 

Colectomy — Excision of a portion of the colon. 

Colorrhaphy — Suture of the vagina. 

Colostomy — Formation of a colonic fistula. 

Colotomy — Incision of the colon. 

Colpeurysis — Dilatation of the vagina. 

Curettage — Scraping. 

Cyst, For, i. e., Membranous sacs containing 
fluid. 

Cyst, Dermoid, For, i.e., a cyst containing bone, 
teeth, or hair, etc. 

Cyst, Follicular, For, i. e., a cyst due to the occlusion 
of small follicle or gland. ^ 

Cyst, Retention, i. e., a cyst due to the retention 
of the secretion of a gland. 

Cyst, Sebaceous, i. e., a retention cyst of a seba- 
ceous gland. 

Cystotomy — Incision of the bladder. 

Ectopic Gestation, For, i. e., extra- uterine preg- 
nancy (pregnancy outside the uterus) . 

Empyema, For, i. e., pus in the pleural cavity. 



334 Practical Nursing 

Enterorrhaphy — Suturing the intestines. 

Enucleation — The shelling out of a tumour. 

Epithelioma, For, i. e., a cancerous growth of the 
skin. 

Evisceration — Removal of the cornea and entire 
contents of the eyeball. 

Fissure, For, i. e., a cleft. 

Gastrectomy — Resection of the pyloric end of the 
stomach. 

Gastroenterostomy — The formation of a fistula be- 
tween the stomach and intestine. 

Gastroenterotomy — An intestinal incision through 
the abdominal wall. 

Gastrorrhaphy — Suture of a wound of the stomach. 

Gastrostomy — The formation of a gastric fistula. 

Hernia, For, i. e. , protrusion of part of the viscera. 

Hernia, Femoral, For, i.e., a hernia through the 
femoral canal. 

Hernia, Inguinal, For, i. e., a hernia into the inguinal 
canal. 

Hernia, Strangulated, For, i. e. y a hernia that is im- 
possible to reduce. 

Hernia, Umbilical, For, i. e., a hernia through the 
umbilicus. 

Hernia, Ventral, For, i. e., a hernia through the 
abdominal wall. 

Hypospadia, For, i. e. , a fissure in the under surface 
of the penis. 

Hysterectomy — Excision of the uterus. 

Hysterorrhaphy — Suture of the uterus. 

Keloid, For, i. e., a tuberculous skin disease. 

Kerectomy — Cutting out of a portion of the 
cornea. 

Laminectomy — Excision of the vertebral lamina. 



Operating-Room Technique, Etc. 335 

Lipoma, For, i. e., a fatty tumour. 

Lupus, For, i. e., a tuberculous skin disease. 

Mastoidectomy- -Incision for mastoiditis ( inflam- 
mation of the mastoid cells) . 

Myomectomy — Removal of uterine myoma (mus- 
cular tumours). 

Nephrectomy — Excision of the kidney. 

Nephrotomy — Incision of the kidney. 

Nephrolithotomy — Incision of the kidney for cal- 
culus. 

Nephropexy — The fixation of a floating kidney. 

Nephrorrhaphy — Suture of the kidney. 

Oophorectomy — Excision of the ovaries. 

Osteomyelitis, For, i. e., inflammation of the mar- 
row of the bone. 

Osteoplastic — Plastic operations upon bone. 

Panhysterectomy — Excision of the ovaries, and 
uterus. 

Perineorrhaphy — Suture of the perineum. 

Plastic Operations — Operations to restore lost or 
imperfect parts. 

Prostatectomy — Excision of the prostate gland. 

Salpingectomy — Excision of a Fallopian tube. 

Salpingo-oophorectomy — Excision of a Fallopian 
tube and ovary. 

Sclerotomy — Incision of the sclera (the outer mem- 
brane of the eyeball). 

Sequestrotomy — Excision of necrosed bone. 

Splenectomy — Excision of the spleen. 

Splenopexy — Fixation of a movable spleen. 

Suprapubic cystotomy — Incision into the bladder 
above the pubes. 

Tenorrhaphy — Suturing of a tendon. 

Thyroidectomy — Excision of the thyroid gland. 



33 6 Practical Nursing 

Torticollis, For, i. e. , contraction of cervical muscles. 

Trachelorrhaphy — Suturing the neck of the uterus. 

Tracheotomy — Incision into the trachea. 

Tumours, For removal of, i. e., a new non-inflam- 
matory growth. 

Tumours, Benign, For, i. e., not malignant. 

Tumours, Cystic, For, i. e. y made up of cysts. 

Tumours, Fibroid, For, i. e. } a fibroma (a tumour of 
fibrous tissue. 

Tumour, Gummatous, For, i. e., a gumma (a tumour 
of syphilitic origin). 

Tumours, Myoma, For, i. e., a tumour of muscular 
tissue. 

Ureterostomy — The formation of an ureteral fistula. 

Ureterotomy — Incision of an ureter. 

Urethrotomy — Incision of the urethra. 

Ventral Fixation — Fixation of the uterus by sutur- 
ing to the abdominal wall. 



CHAPTER XXIII 

A SYNOPSIS OF IMPORTANT DISEASES 

Communicable, Contagious, and Infectious Diseases. Isola- 
tion and Disinfection in Infectious Diseases. Anthrax. 
Chicken-pox. Cholera. Diphtheria. Pseudo-diphtheria. 
Dysentery. Erysipelas. Gonorrhoea. Hydrophobia. Influ- 
enza. Leprosy. Malaria. Malta Fever. Measles Measles 
(German). Meningitis. Mumps. Plague. Pneumonia. 
Rheumatic Fever. Scarlet Fever'. Septic Diseases. Small- 
pox. Syphilis. Tetanus. Tuberculosis. Typhoid Fever. 
Typhus Fever. Whooping Cough. Yellow Fever. Diseases 
due to Animal Parasites. 

Part I 

Communicable, Contagious, and Infectious Diseases 

DISEASE is the result either of germ invasion 
or of abnormal changes generated within the 
body as a natural sequence to irritation, debility or 
degeneration of the organs of the body due either to 
inherited or acquired weakness. 

Diseases due to micro-organisms are known as com- 
municable, contagious, and infectious. 

i. Communicable. A communicable disease is 
one which may be transmitted either directly or 
through an intermediary host, as malaria or yellow 
fever, the intermediary host in both these cases being 
a distinct species of mosquito. 

2. Contagious. A contagious disease is one which 
is readily communicable. It may be contracted by 

337 



33% Practical Nursing 

any one coming within a certain radius of the patient, 
or by coming in contact with anything that has been 
near the patient and not properly disinfected, e. g., 
scarlet fever, measles, etc. 

3. Infectious. An infectious disease is a disease 
caused by the entrance into the body and the prolifer- 
ation there of pathogenic micro-organisms. 

Diseases such as cholera, tuberculosis, and typhoid 
are infectious but not contagious, because, though 
they are due to germ infection, they can be contracted 
only by direct contact either with the specific excreta 
containing the medium of infection or by something 
which has been soiled by the same and not properly 
disinfected. 

Bacteria which cause disease gain entrance to the 
body, with few exceptions, either through the respira- 
tory or alimentary tracts, and not — like those produc- 
ing inflammation of the cellular tissue, suppuration, 
and other complications of surgery — through abra- 
sions in the skin and mucous membrane. 

When a disease attacks many people at the, same 
time, it is said to be epidemic; when the epidemic is 
confined to some particular locality it is called en- 
demic; when it spreads over the greater part of the 
world it is known as pandemic. Cases which occur 
singly, and independently of any discoverable infec- 
tion are called sporadic. 

Stages in Infectious Disease 

The stages in infectious disease are: 

1. Incubation. Incubation is the period between 
the exposure of the person to the disease and the ap- 
pearance of the symptoms. The patient may feel 



A Synopsis of Important Diseases 339 

perfectly well during this time, or there may be 
malaise and slight febrile symptoms, which are spoken 
of as prodromal symptoms. 

2. Invasion. The appearance of the active symp- 
toms of the disease is called the invasion. 

3. The febrile or active stage. 

Certain infectious diseases are characterised by 
specific eruptions, which are known as the exanthe- 
mata. In such diseases, the eruptive stage is followed 
by desquamation, and, in the majority of cases, isola- 
tion is necessary till this has entirely ceased. 

Disinfection in Infectious Disease 

The prophylactic measures required in infectious 
diseases vary in the different types. Thus, in mala- 
ria and yellow fever, the destruction of and protection 
from the intermediary vehicle of infection is all that 
is required. 

In infectious diseases, the amount of disinfection 
necessary varies in different cases. The discharges 
and excreta containing the germ should always be 
either burned or disinfected. The linen and utensils 
used by the patient and the hands of the nurse, after 
attending to him, should be thoroughly disinfected. 
Soiled linen taken from the bed of a patient suffering 
from an infectious disease should never be placed on 
chairs or tables, but put immediately into a pail or 
other receptacle containing water kept for the purpose, 
and carried in this to the disinfecting room. 

Linen is disinfected either by exposure to live steam, 
boiling, or soaking in a disinfectant. Carbolic i : 40 or 
formaline solution %% are the disinfectants most com- 
monly used. When it is impossible to disinfect linen 



34° Practical Nursing 

immediately, it should be kept submerged in water. 
Utensils and dishes are disinfected in the same way. 
Where it is impossible to disinfect these thoroughly, 
they should be kept separate from those used by other 
people : also, the towels used for drying them. 

When caring for patients suffering from an infec- 
tious disease, a nurse should always have her sleeves 
rolled up to or above her elbows, that the cuffs may 
not become infected, so endangering herself and 
others. After attending to the patient, she should 
immerse her hands in a disinfectant (bichloride of 
mercury 1:1000 is frequently used) before touching 
anything, and then wash them with soap and hot 
water. This point must be remembered. Nurses 
are constantly washing their hands and touching 
their faces, screens, door handles, etc., before disin- 
fecting them. 

In contagious cases, complete isolation of the 
patient, of everything, and of every one coming 
within a certain radius of him, is essential. 

Isolation and Disinfection in Contagious Diseases 

When a patient is isolated, no one but the physi- 
cians and nurses should be allowed to enter the room, 
unless permitted by the physicians. 

The Room. — When possible two rooms and an ad- 
joining bathroom should be given up to the patient 
and his attendants. These should be on the top floor 
of the house, or if in a flat, in the most isolated portion. 
Other important points to consider in choosing the 
sick-room are the exposure to sun and daylight and 
facilities for ventilation. An abundant supply of 
sunlight is absolutely essential, and the ventilation 
must be continuous, and so arranged that the air from 



A Synopsis of Important Diseases 34 1 

the sick-room will not pass through other rooms. To 
guard against this it is well to hang a sheet wet in a 
disinfectant inside the closed door. When the room 
is prepared for the patient, before he is taken to it, 
remove all unnecessary furniture, rugs, ornaments, 
draperies, and clothing, and exchange all valuable arti- 
cles of furniture for such as will not be destroyed by 
the use of disinfectants. When the patient — if ill 
with an infectious disease — is already in the room 
nothing must be taken from it without first being dis- 
infected. Put away all superfluous draperies and 
other unnecessary articles in a cupboard or drawer, 
and disinfect them when the room is fumigated after 
case is over. 

The room must be dusted daily with a duster moist- 
ened in a disinfectant. Cover the broom used for 
sweeping with a duster likewise moistened. After 
use, these dusters should be soaked in a disinfectant 
and then washed. At the close of the disease the 
room must be fumigated or disinfected. In doing 
this, seal all ventilators, key -holes, cracks, and seams 
around windows and doors by pasting paper over 
them; open all cupboards and drawers; pull down 
shades, and hang rugs, clothing, etc., over lines 
stretched across the room, that the fumes of the disin- 
fectant may permeate them. 

Formaldehyde gas is the disinfectant most com- 
monly employed at present. It has many advantages 
over any previously discovered, viz. : it is really a ger- 
micide, is easy to use, and does not change the colour 
or harm fabrics of any kind, wall paper, paint, leather, 
or metal. There are several different lamps and 
preparations for generating this gas. 

The lamps are generally considered more efficient 



34 2 Practical Nursing 

than the compressed candles and cones of formalde- 
hyde. Instructions for use are written on the boxes 
containing the various apparatus and preparations. 
In all instances, the room must be left closed for at 
least eight hours. It is then opened and aired for 
several hours before being cleaned. 

Sulphur was formerly almost entirely used for fumi- 
gating, but it has been proven that it is much less 
efficient than formaldehyde. Besides, it discolours 
and injures many fabrics. 

To use sulphur : Put in a tin case three pounds of 
sulphur for every iooo cubic feet of air space to be 
fumigated. Place this on a brick or inverted tin, in 
a saucepan or tub of water. Pour some alcohol over 
the sulphur, light it (burning coals can be used in- 
stead of alcohol), and leave the room immediately. 
Seal the cracks and keyhole. The room is left 
thus for twenty-four hours, after which, as when 
formaldehyde is used, it is opened and aired. 

Fumigation by sulphur is not very efficient, however, 
especially in scarlet fever, and further treatment is, 
therefore, necessary. The walls should be rubbed 
down with bread and the crumbs burned. The wood- 
work should be washed with bichloride 1:1000, or 
formaline 2%, and all metal should be washed with 
carbolic 1 : 20 or formaline. 

Dishes. — The most convenient way of caring for 
the dishes used by the patient and nurse is to place 
them in a metallic vessel containing water. This 
vessel should be draped in a sheet wrung out in a dis- 
infectant outside the door of the isolated room. 
Once in each twenty- four hours it should be removed, 
— by some one who has not been in the sick-room — 
to the kitchen stove and its contents thoroughly boiled 



A Synopsis of Important Diseases 343 

for twenty minutes in the same vessel. When the two 
rooms have been isolated, a gas stove can be kept in 
the outer one and the dishes boiled there after use. 
Unused food can be put into a covered pail likewise 
draped and kept outside the room. This food should 
be carried to the kitchen and burned at least three 
times in each twenty- four hours. 

Bed Linen. — Bed linen, towels, and such articles 
can be removed to the kitchen and boiled in the water 
in which they are carried down, or they can be car- 
ried to the kitchen in a sheet wet in disinfectant or put 
directly into a boiler of water and boiled one-half hour. 

Excreta. — Urine and faeces should be received into 
a vessel containing a disinfectant such as carbolic 1:20, 
formaline 2%, or fresh solution of chloride of lime 1%. 
After the vessel has been used add a quantity of 
disinfectant equal to the amount of excreta. Mix 
the two thoroughly and set aside for at least half 
an hour before emptying into the closet. Keep a dis- 
infectant in the bed-pan when it is not in use. Before 
giving the bed-pan to the patient rinse it in hot water 
and dry it, since there is danger that the strong disin- 
fecting solutions will burn the patient. 

Sputum Cups. — Paper sputum cups, or gauze hand- 
kerchiefs, which can be burned are preferable. When 
necessary to use china cups, they must be one-fourth 
filled with a disinfectant, emptied and boiled at least 
twice in each twenty- four hours. 

Nasal Discharges. — Xasal discharges should be re- 
ceived on gauze handkerchiefs, and, in such a disease 
as diphtheria, these should be burned immediately (in 
a covered pail outside the window), or, if this is not 
convenient, thrown into a covered sputum cup con- 
taining a disinfectant and burned as soon as possible. 



344 Practical Nursing 

The Patient. — For the patient, the first considera- 
tion is absolute cleanliness. The patient should be 
bathed daily unless the doctor has ordered otherwise. 
The mouth should be cleansed before and after each 
feeding, and any residue of sputum, nasal or aural dis- 
charge, should be removed immediately. The but- 
tocks and perineum should be washed after each stool. 
When desquamation begins, the skin should be 
anointed daily with some oily substance to prevent 
its dissemination. After recovery, the patient should 
be given a warm bath and shampoo with bichloride 
1 15000, rolled in a sheet, which has not been in the 
isolated rooms, and taken to another room where he 
can be dressed as desired. 

The Physician. — A large gown (one can be impro- 
vised with a sheet), see Chapter XXII, a cap (one can 
be improvised with a small towel or table napkin) , and 
a pair of rubbers should be kept ready for the doctor 
to put on when he enters the sick-room. These should 
hang in the outer room if there are two rooms.. If 
not, they should be rolled in a disinfected sheet and 
kept in a drawer or cupboard in the sick-room. A 
basin of hot water, soap, and disinfectant should 
be ready for the doctor to use before leaving the 
room. 

The Nurse. — The nurse should never leave the 
room without washing her face and hands with bi- 
chloride and attiring herself as the doctor does when 
he enters the room. Her gown, etc., should hang 
just outside the door of one of the isolated rooms under 
a sheet or curtain. She should never loiter when 
going through the house. While in the sick-room, 
she should wear a cap that will completely cover her 
hair. When going out of doors, she should take a 



A Synopsis of Important Diseases 345 

bath, wash her face and hands with bichloride, and 
change all her clothes. 

For her own protection, she should observe the fol- 
ing rules: She should, if possible, take a daily walk in 
the fresh air; disinfect and wash her hands before 
meals, and rinse her mouth with listerine or other dis- 
infectant mouth wash. Unless absolutely unavoid- 
able she should not take her meals in the sick-room 
but when this is necessary the tray should never be 
allowed to stand uncovered. When irrigating a diph- 
theria patient's throat she should wear glasses to pro- 
tect her eyes, and a piece of gauze tied over her mouth, 
as the patient frequently coughs up pieces of mem- 
brane very forcibly. Another very important point 
to remember, and one which, when nursing, it is well 
to observe at all times, is, not to put the hands to the 
face and especially near the mouth or eyes. More 
than one nurse has lost her eyesight by doing the 
latter. 

At the termination of the case, the disinfection for 
the nurse is practically the same as for the patient. 

Anthrax 

Anthrax is a disease contracted by man from ani- 
mals. The bacillus anthracis is the cause of infection. 
It is now rarely seen in this country. 

Incubation. — The incubation period varies from a 
few hours to three days. 

Chicken- Pox (Varicella) 

The specific cause of chicken-pox is not known. It is 
transmissible from the stage of invasion till the crusts 
have disappeared. 



34 6 Practical Nursing 

Incubation. — The period of incubation is ten 
to seventeen days, generally two weeks. 

Symptoms. — The invasion is generally sudden, but 
mild. There may be vomiting, restlessness, and slight 
pains in the back and legs. 

Eruption. — The eruption appears within twenty- 
four hours upon the face, scalp, and neck; later, upon 
the extremities and the back. In some respects, the 
eruption resembles that of small-pox. But, though 
the macule appears in the first stage of chicken-pox, 
it changes to a vesicle in a few hours. The spots are 
never umbilicated, as in small-pox, the fluid con- 
tained in the vesicle is thinner, and, unless infected, 
it seldom becomes pus. Crusts form by the fourth 
or fifth day, and fall off in a few days. New crops 
sometimes appear before the earlier ones have faded. 
Scratching or uncleanliness will result in scars. 

Temperature.— There is seldom much fever. The 
temperature only ranges from ioo° F. to 102 F. for 
the first two or three days and, then, falls to about 
normal. 

Nursing. — The patient should be isolated till the 
crusts disappear. The body should be sponged daily 
and the crusts well oiled. The hands are sometimes 
covered with mittens, and tied to prevent scratching. 

A thorough cleansing and airing of the room at the 
close of the disease is all that will be needed by way 
of disinfection. 

Cholera (Cholera Vera) (Asiatic Cholera) 

Cholera occurs principally among the natives of 
India and China. Filth and hot weather further its 
propagation. It is caused by the spirillum cholerae 



A Synopsis of Important Diseases 347 

asiaticas, 1 which enters the system through the mouth 
and is discharged in the intestinal evacuations. 
Water and clothing, which have been contaminated 
with the faeces of the rectum, and flies, which have 
rested upon the same and then upon articles of food, 
are the most common vehicles for spreading the 
disease. 2 

Incubation. — The period of incubation is three to 
five days. 

Symptoms. — There are four distinct stages of the 
disease : 

i. The premonitory stage, which is marked by a 
slight fever, nausea, vomiting, headache, diarrhoea, 
and prostration. 

2. The stage of serious purging. In this stage, 
which may only last a few hours, there is a constant 
purging of a serous, frothy, alkaline fluid, containing 
small white particles of epithelium, whence the name 
"rice water stools." The skin is cold, wrinkled, and 
livid. There is intense thirst, vomiting, pain in the 
legs and abdomen, a diminished secretion of urine, 
and rapid emaciation. 

3. The algid stage, or stage of collapse: In this 
stage, the vomiting and diarrhoea cease, but the 
patient sinks rapidly into a stage of collapse or per- 
haps coma. Asphyxia, due to the weakened action 
of the heart is often present, and tonic convulsions of 
the muscles cause intense agony. The patient often 
dies in this stage from heart failure. 

4. The reactionary stage. If the patient does not 
die in the algid stage he passes into this stage in which 

1 Discovered by Koch in 1884. 

2 In times of epidemic all water used for drinking should be 
boiled and onlv cooked foods eaten. 



34 8 Practical Nursing 

the symptoms abate, the surface of the body becomes 
warmer, and recovery slowly ensues. 

Nursing. — Rigid isolation must be maintained. 
To lessen the danger of heart failure the patient must 
be kept absolutely quiet. The maintenance of con- 
tinual external heat, to lessen the danger of collapse, 
is essential. 

Hypodermoclysis and enteroclysis of hot saline 
solution are now commonly given to counteract the 
effect of the constant purging upon the system. 

Diphtheria 

Etiology. — Diphtheria is an acute contagious dis- 
ease characterised by the production of a greyish-white 
membrane, and by grave constitutional symptoms. 
It is caused by the Klebs-Loffler bacillus. 1 

Infection. — Diphtheria may attack any of the 
mucous membranes and the skin. The germs enter 
the body either through abrasions in the cuticle or 
through the respiratory tract. The posterior pharyn- 
geal walls, the larynx, and the trachea are the most 
frequent seats of the disease. In diphtheria of the 
throat and nose, the infection is usually given off in 
the discharges when coughing. In diphtheria of the 
other mucous membranes, the skin, and cellular tis- 
sue, the infection is given off in the discharges from 
the affected part. 

When proper care is taken to prevent all discharges 
containing the germs from drying and being blown 
about, the air directly surrounding the patient only 
will be infected. For this reason, patients suffering 
from diphtheria may be more easily isolated at home 

1 So called because discovered by Klebs and Loffler (1893). 



A Synopsis of Important Diseases 349 

than those afflicted with small-pox, scarlet fever, and 
measles. The germ is, however, long lived, and a 
severe epidemic may result from lack of disinfection 
or improper disinfection. 

Incubation. — The period of incubation is one to 
seven days. 

Symptoms. — General malaise, sore throat, 1 but not 
much fever. 

Temperature. — The temperature is irregular, but 
it seldom rises above 102 ° F. It lasts a week or ten 
days in ordinary cases and goes by lysis. 

Pulse. — The pulse is frequent, and, in a case of any 
severity, will be weak and irregular. A pulse below 
sixty, or one above 120, indicates cardiac weakness. 

The Throat. — The throat is first red and swollen. 
By the end of the first day, a pale grey membrane 2 
forms and spreads rapidly, becoming thicker and more 
opaque. If stripped off, it leaves a bleeding surface 
and will quickly reform. On recovery, the mem- 
brane curls at the edges and comes off in flakes. 

In laryngeal cases, the membrane is not always 
seen, and, apart from the general malaise, the dreaded 
diphtheritic croup may be the first intimation of its 
presence. Such cases are always more serious than 
pharyngeal diphtheria. So also is the nasal form. 
In the latter, the child will have snuffles, mouth- 
breathing, sneezing, and a thin, putrid discharge 

1 A sore throat with low temperature should always be re- 
garded with suspicion, especially if the temperature remains 
low after a membrane forms. 

2 This membrane is supposed to be the result of the coagula- 
tion of the inflammatory exudate (which has transuded from 
the capillary walls) by a ferment derived from the disinte- 
grated leucocytes. 



35° Practical Nursing 

from the nose, containing the Klebs-Lomer bacillus. 
The toxaemia is very great in these cases. 

The most common causes of death in diphtheria are 
toxaemia, asphyxia, and sudden heart failure. 

Dyspnoea, which is often severe, is, in diphtheria, 
not only the result of obstruction in the breathing, but 
also of the toxaemia. 

Complications. — The most frequent complications 
are: heart failure, acute nephritis, broncho-pneumonia, 
and paralysis (particularly of the recti muscles of the 
eye, the muscles of the tongue, and those of degluti- 
tion). Regurgitation of the food is the premonitory 
symptom of the latter, and, whenever this happens, 
it should be reported to the doctor. 

Nursing. — Isolation of the patient should extend 
from the first throat symptoms till two cultures 
show absence of the Klebs-Loffler bacilli. l Particular 
attention must be paid to the pulse, because heart fail- 
ure is a very common complication. Spraying and 
irrigation of the throat must be faithfully performed, 
as much depends upon it. When spraying the throat, 
the nurse should wear glasses to protect her eyes, and 
tie gauze loosely over her mouth and nose. Calomel 
fumigation is often used (see Chapter XV). It is 
often difficult to make the patient take sufficient nour- 
ishment, but this should be insisted upon, it being 
very necessary to keep the patient well nourished in 
order that the system may be better able to combat 
the toxic effects of the disease. Since the advent of 

1 An exception is made to this rule in cases in which the 
bacilli persist longer than one month after the disappearance 
of the membrane. It has been demonstrated that, after that 
length of time, the germ is not more noxious than that 
found in the throats of those in health. 



A Synopsis of Important Diseases 35 r 

antitoxine the need for intubation has decreased enor- 
mously. Antitoxine is now given as soon as the diag- 
nosis is made, and is sometimes repeated in twelve or 
twenty-four hours. It is also given to all those who 
have been exposed to the disease. 

Pseudo-Diphtheria 

Pseudo-diphtheria often complicates such diseases 
as scarlet fever and measles. The lesion is much the 
same in appearance as in the true diphtheria, but it 
is less adherent and is more often limited to one tonsil. 
Furthermore, the temperature is higher and the tox- 
aemia less than in diphtheria. 

This disease is caused by streptococci or by bacilli 
very closely resembling the Klebs-Lofrler bacilli, but 
not by Klebs-Lofrler bacilli. 

Dengue (Break-Bone Fever) 

The specific cause of dengue is unknown. It occurs 
chiefly in Southern and tropical climates. 

Incubation. — The period of incubation is one to 
four days. 

Symptoms. — The symptoms of dengue in its initial 
stage are: Sudden rise of temperature ioi°-io3°F. ; 
intense pain in the bones, muscles, head, and eyes; a 
slight rash, which is sometimes not more than a red- 
ness of the skin, but which is often associated with an 
intense itching. The temperature falls on the third 
or fourth day and remains low for twenty-four or 
thirty-six hours, after which there is a secondary but 
milder attack. The rash in the second attack is pap- 
ular in character. It may appear only in spots, or 
may spread over the body. It fades in a day or two 
and is followed by a fine mealy desquamation. 



35 2 Practical Nursing 

Dysentery 

Dysentery is a disease of the lower bowel. There 
are four distinct forms: Acute catarrhal dysentery, 
croupous dysentery, amoebic dysentery, and acute 
specific dysentery. 

Acute Catarrhal Dysentery. — The specific cause 
of acute catarrhal dysentery has not yet been posi- 
tively ascertained. It occurs at all ages, but espe- 
cially in children. Unsanitary surroundings, hot 
weather, and unsuitable food are predisposing 
causes. 

Symptoms. — It usually begins with an ordinary diar- 
rhoea, the stools gradually becoming more and more 
frequent and containing mucus, divers bacteria, 
epithelium, and sometimes blood and pus, but no 
faecal matter. There is severe intestinal colic, which 
is relieved by abdominal pressure, thirst, anorexia, 
and sometimes vomiting. The temperature varies 
from ioi° to 104 . 

The continued appearance of faecal matter in the 
stools, with the diminishing of the stools and of the 
abnormal constituents will be the first symptoms of 
convalescence. Continued acute attacks of dysen- 
tery or wrong treatment of the same is liable to end 
in a chronic catarrhal condition of the intestine. 

Croupous, or Diphtheritic Dysentery. — The 
specific cause of croupous dysentery is unknown. 

Symptoms. — The onset is abrupt, the fever rising 
almost immediately to io4°-io5° F. There is intense 
abdominal pain and tympanites. The diarrhoea is 
not as constant as in the catarrhal form of the disease, 
but the stools are larger. They contain blood, pus, 
mucus and faecal matter, sloughs, and various 



A Synopsis of Important Diseases 353 

bacteria. In two or three days a marked typhoid 
condition occurs. 

Death often occurs in one to three weeks. If the 
patient recovers, convalescence is slow r , and relapses 
are common. 

Amcebic Dysentery. — Amoebic dysentery is more 
common in tropical countries. It is supposed to be 
caused by the amoeba dysenteriae. 

Ulcers form in the caecum and flexures of the colon 
and rectum followed by necrosis and sloughing of the 
mucous surface of the same. 

Abscess of the liver is a common complication. 

Symptoms. — Frequent, offensive, watery stools 
containing mucus, albumin, and sometimes blood. 
There is colic, rapid emaciation, and the patient soon 
becomes anaemic. The tongue is usually much coated. 
The temperature is seldom high, but often subnormal. 

Death often occurs within a few days from haemor- 
rhage, perforation, peritonitis, or exhaustion. At 
other times the disease continues for months and 
either terminates fatally or in a long convalescence 
or becomes chronic. 

Acute Specific Dysentery. — The bacillus of Shiga 
is now supposed to be the cause of this form of dysen- 
tery. It is more common in hot countries. 

Symptoms. — The onset is acute, but the tempera- 
ture is not high during the first few hours of the dis- 
ease. It rises, however, on the second or third day 
to 103 or 104 F., and, unless death intervenes, or the 
case is unusually mild, remains at that point for two 
or three weeks. There will be colic, thirst, and all 
other symptoms of dysentery. 

Nursing Dysentery. — Fresh air, cleanliness, quiet, 
and the application of external heat are four of the 
23 



354 Practical Nursing 

most essential points to be remembered in nursing 
all forms of dysentery. Rectal irrigations are often 
ordered. They must be given very slowly, otherwise 
intense pain will be excited. During the acute attack, 
the patient is, as a rule, kept on a Pasteurised milk 
diet. As convalescence begins, the diet is slowly in- 
creased by the addition of arrowroot, milk puddings, 
and other easily and quickly digested foods. All 
highly flavoured foods must be avoided, spices and 
other flavouring extracts being irritating to the 
intestines. 

Erysipelas 

Erysipelas is caused by the streptococcus erysi- 
pelatis. It enters the body through abrasions or 
wounds in the skin or mucous membrane. 

Incubation. — The period of incubation varies from 
three to fourteen days. 

Symptoms. — In severe cases there are generally a 
chill, followed by a rise of temperature from 103 F.- 
104 F., and the usual constitutional symptoms asso- 
ciated with fever. The tissues of the affected part 
become red and swollen, and there is a strong line of 
demarcation around the edge of the inflamed area. 

In facial erysipelas, the inflammation usually begins 
on the bridge of the nose or around the mouth. It 
may spread over large areas of the body. When this 
occurs, the disease is known as migratory erysipelas. 
Such cases may be protracted for weeks. In ordi- 
nary cases, convalescence occurs at the end of one or 
two weeks. 

Complications. — Complications are rare; but ab- 
scesses, malignant endocarditis, pneumonia, nephritis, 



A Synopsis of Important Diseases 355 

and, in cases where the larynx is involved, oedema 
of the glottis sometimes occur. 

Nursing. — The danger of infection is limited to 
wounds, so that absolute isolation, except in a surgical 
ward, is unnecessary; but all discharge and soiled 
dressings should be disinfected or burnt immediately. 
The nursing is the same as in all cases of fever. 

Gonorrhoea 

Gonorrhoea is an acute, infectious, and virulent pro- 
cess which attacks most frequently the mucous mem- 
brane of the urethra and the structures in anatomical 
relation with it, though other parts of the body, espe- 
cially the eye, 1 may be the seat of infection. 

Gonorrhoeal Arthritis 

Gonorrhoeal arthritis is due to the presence of gono- 
cocci in the joints. 

Symptoms. — The symptoms are in some respects 
similar to those of rheumatism; but the fever and 
constitutional symptoms are slight, and the swelling 
in the joints is seldom present in the beginning of the 
attack Urethral discharge should be watched for 
in such cases, and nurses should be careful to disinfect 
their hands thoroughly after caring for the patient. 

Gonorrhoeal Vaginitis 

The vaginal mucous membrane is reddened and cov- 
ered with papillae. There is a profuse discharge, 
which is serous at first, but soon becomes a thick, puru- 
lent pus. The condition is highly contagious and 
has been known to spread rapidly through an entire 

> See Diseases of the Eyes. 



35 6 Practical Nursing 

hospital ward. Children are particularly susceptible. 1 
Too much stress cannot be laid upon the importance 
of the immediate isolation of the patient, and of the 
careful disinfection of the articles coming in contact 
with her, and of the hands, after touching her or such 
articles. 

Hydrophobia (Rabies) 

The specific germ of hydrophobia has not yet been 
isolated ; 2 but the toxin which it develops is obtained 
from the central nervous system and the secretions 
of animals suffering from the disease. Man most fre- 
quently contracts the disease by inoculation with the 
saliva of such animals when bitten by them. 

Incubation. — The period of incubation averages 
six weeks, but may be longer — five or six months. 

Symptoms. — The onset is gradual and is character- 
ised by pain and congestion in the cicatrix, together 
with great mental depression, irritability, and hyper- 
aesthesia of the special senses. This is followed by the 
spasmodic stage, in which the nervous symptoms are 
all increased and convulsions may be induced by at- 
tempting to swallow, by noise, or even by draughts 
of air. The pain in the laryngeal muscles is severe, 
dyspnoea is at times intense, the respiration is spas- 
modic, and there is foaming at the mouth, due to 
the excess secretion of saliva caused by the constant 

1 Xurses are always held responsible for. the spread of this 
disease in a hospital ward. They should therefore be keen 
in recognising and reporting the presence of any vaginal dis- 
charge. 

2 Recent investigation makes it seem probable that it is 
caused by protozoa, *. e., bodies found in large nerve cells of 
animals dying of rabies. 



A Synopsis of Important Diseases 357 

spasm of the jaws. The temperature varies, being 
subnormal in some cases, while in others there is a 
moderate fever of ioo° to 102 ° F. The stage of paraly- 
sis is marked by the cessation of spasms, and a 
paralysis of the muscles and nerves of sensation. 

Prognosis. — Death results in from 60 to 80 per 
cent, of the cases of hydrophobia. Bites on exposed 
surfaces such as the face and hands are the most dan- 
gerous. When they are on other parts of the body, 
the clothing absorbs a certain amount of the saliva 
and thus lessens the infection. 

Treatment. — Immediately after the accident, ap- 
ply a cupping-glass to the wound or suck the poison out 
and then cauterise the part. If the wound is on the 
extremities, first apply a tight bandage above it, and 
leave this on till the wound has been cauterised. In 
localities where the specific antitoxine virus can be 
obtained, the patient should be inoculated with it 
as soon after the accident as possible. 

Nursing. — Extreme quiet in a darkened room is 
one of the most important specific points in the nurs- 
ing. It is often necessary to feed the patient by gav- 
age. While doing so, or while cleansing the mouth, 
a gag should be used to prevent the tube or fingers 
from being bitten. The wearing of rubber gloves when 
performing these offices is a safe precaution. 

Influenza 

Influenza is an acute, infectious disease, due to the 
bacillus of Pfeiffer. 

Incubation. — The period of incubation is from two 
to four days. 

Symptoms. — The symptoms vary considerably in 
different cases. The onset is generally sudden. There 



35 8 Practical Nursing 

may be a slight chill followed by rise of temperature. 
There are an intense aching of the muscles, especially 
those of the legs and lumbar region, coryza and catarrh 
of the throat and bronchi, the discharges from which 
will contain the infection. Nervous symptoms, such 
as headache, prostration, and neuritis, predominate 
in some cases, while others are characterised by severe 
abdominal and gastro-intestinal phenomena. There 
is seldom leukocytosis. 

Temperature. — The temperature varies consider- 
ably, according to the severity of the case. In mild 
cases, it remits between ioo° and 102 F., while in 
severe cases it will remain persistently between 103 
to 104 F. It falls by lysis. When uncomplicated, 
recovery will probably be fairly well established in 
two or three weeks, though a feeling of lassitude and 
depression may persist for some time. 

Complications. -^Otitis media, bronchitis, and 
pneumonia are the most common complications. 

Nursing. — The disinfection necessary for all infec- 
tious diseases should be carried out. The general 
care is the same as in all fever cases. 

Leprosy 

Leprosy is a chronic infectious disease caused by 
the bacillus leprae. Infection is transmitted by direct 
contact and by fomites, the germ entering the body 
through abrasions in the skin or mucous membrane. 

There are two types of the disease: (1) tubercular 
leprosy, characterised by the formation of tubercular 
nodules in the skin and mucous membrane, followed 
by ulceration, which sometimes erodes so deeply that 
the loss of fingers and toes results. (2) Anaesthetic 
leprosy, in which, owing to the invasion of the nerve 



A Synopsis of Important Diseases 359 

trunks by the bacilli, portions of the skin become an- 
aesthetic and the muscles of the extremities contract 
and atrophy. 

Nursing. — There need be no fear of infection if all 
abraded surfaces on the hands are protected and the 
hands are carefully disinfected after doing anything 
for the patient or touching anything that has come 
in contact with him. The patient must be kept well 
nourished, clean, and as much as possible in the open 
air. The ulcers should be treated as a wound. 

Malaria. 

Malaria is an endemic, infectious disease caused by 
a unicellular animal organism. It is characterised 
by an enlarged spleen and by paroxysms of chill, fever, 
and sweating, which occur at definite intervals. A 
certain species of mosquito (the female of the Anophe- 
les maculipennis) is now known to be the only vehicle 
of transmission. 

Malaria is more prevalent in southern and tropical 
countries, and, particularly so where the land is low, 
marshy, or badly drained. 

There are five distinct varieties of the disease: 

i. Intermittent malarial fever. 
Remittent malarial fever. 
^Estivo- autumnal (summer- autumn) fever. 
Pernicious malaria. 
Chronic malaria or malarial cachexia. 

Intermittent Malarial Fever. — The intermit- 
tent type of the disease is the most common. 

According to the number of hours between the chills 
(which always occur at regular intervals) , intermittent 
malaria is known as single tertian, double tertian, or 
quartan intermittent fever. 



360 Practical Nursing 

In single tertian, the paroxysms occur every forty- 
eight hours, the tertian parasite requiring forty- eight 
hours to develop 1 and form its spores. 

In double tertian (also called "quotidian") fever, 
the paroxysm occurs every twenty-four hours. In 
double tertian, there are two broods of parasites in 
the blood, and each brood completes its development 
upon a different day. 

In quartan intermittent fever, the paroxysms recur 
every seventy-two hours, the quartan parasite taking 
longer to complete its cycle. There will be a double 
quartan, or a triple quartan, if the broods develop on 
different days. 

During the malaria chills, the temperature of the 
skin is lowered, but the blood temperature is high, 
105 to 106 F. The chill over, the patient feels in- 
tensely hot, even though the blood temperature is 
often not higher than during the chill. This stage 
may endure for some hours. It is generally, though 
not always, followed by a profuse sweating; but, even 
when the perspiration is absent, the temperature falls 
to or below normal in from twelve to sixteen hours. 

The pulse during the paroxysm is rapid and hard. 
There will probably be headache, nausea, and vomit- 
ing. 

Anaemia is liable to complicate repeated attacks of 
any of the types of malaria, owing to the destruction 

iUpon inoculation, the malarial organisms make their way 
into the red blood corpuscles, each one taking possession of a 
different corpuscle. Here they grow, and as they become 
larger, they separate, forming spores. These spores break 
out of the corpuscles into the blood where they remain a short 
time and then enter other red blood corpuscles. It is when 
the spores break loose that the chill occurs. 



A Synopsis of Important Diseases 361 

of the red blood corpuscles by the malarial organisms. 
Herpes labialis is frequently present. 

Remittent Malarial Fever. — Remittent malarial 
fever is the result either of a mixture of the above spe- 
cies of malaria or of an irregular development of differ- 
ent broods of the same species. In this type there 
is no decided remission of fever, the temperature 
remaining continuously high. 

iEsTivo- Autumnal Fever. — In aestivo- autumnal 
fever the paroxysms vary and are of longer duration, 
the fever having a tendency to become remittent in 
time. This is a more serious form of malaria than 
either of the other two. It is more common in tropi- 
cal countries. 

Pernicious Malaria. — Pernicious malaria is sel- 
dom seen except in tropical lands. When it does not 
follow aestivo-autumnal fever, its onset is generally 
very sudden. It usually begins with a chill which is 
followed either by violent delirium or rapidly devel- 
oping coma. The prognosis is bad. 

Chronic Malaria or Malaria Cachexia. — ■ 
Chronic malaria is generally the sequence of repeated 
attacks of intermittent malaria. 

The most prominent symptoms are varying fever, 
anaemia, and enlarged spleen, the rupture of which 
sometimes causes death. In severe cases haemor- 
rhages may occur from the mucous membrane. 

An enlarged spleen is one of the diagnostic physical 
symptoms in all forms of malaria. 

Nursing. — During the chill, keep the patient well 
covered, having a blanket next his body. Place hot- 
water bags at his feet, in the axilla, and over the heart. 
Give hot drinks, unless there is nausea. During the 
hot stage, apply cold compresses to the head, and, un- 



362 Practical Nursing 

less the patient is ordered sponge baths, give frequent 
alcoholic rubs. In this disease the patient should be 
screened to keep out the mosquitoes so that the infec- 
tion be not carried to others. 

Malta Fever (Mediterranean Fever) (Neapolitan Fever) 

Malta fever is an acute infectious epidemic and 
endemic disease. It is found chiefly in cities border- 
ing the shores of the Mediterranean, but also, to some 
extent, in other hot countries. 

Incubation. — The period of incubation varies from 
a few days to a fortnight. 

Symptoms. — In the beginning, the disease resem- 
bles typhoid, but the fever is remittent. After two or 
three weeks it reaches normal, 'remains so for two or 
three days, and is then followed by a relapse, which is 
often more severe than the primary invasion. It is 
marked by frequent chills, a high, but intermittent 
temperature, delirium, diarrhoea, excessive weakness, 
and a tendency to collapse. This stage may endure 
for five or six weeks. Recovery may then take place, 
or, after a few weeks or even months of convalescence, 
another relapse may occur. 

Nursing. — The treatment and general care of the 
patient is the same as in typhoid fever. 

Measles (Rubeola) 

Measles is undoubtedly the result of a germ infec- 
tion, but the specific organism has not yet been iso- 
lated. It is highly contagious, but the infection is 
usually less severe and shorter-lived than that of 
scarlet fever. 

Measles are contagious from the onset until des- 
quamation ceases. 



A Synopsis of Important Diseases 363 

Incubation. — The period of incubation is ten to 
fourteen days. 

Symptoms. — A child during the incubation of 
measles will probably be fretful and feverish. The 
invasion is characterised by a gradually rising tem- 
perature, coryza, sneezing, cough, and a thin nasal 
discharge. Nausea and vomiting are also common. 

Eruption. — The eruption appears on the fourth 
day. It can often be first seen on the mucous mem- 
brane of the mouth. Later it appears successively 
upon the chin, forehead, sides of the throat, face, and 
chest. It consists of red elevated spots that tend to 
coalesce into crescent-shaped blotches but which do 
not become confluent as in scarlet fever. The rash 
persists for from two to five days and then fades, in 
the order of its appearance, and is followed by a fine, 
mealy desquamation that will continue for a week or 
more. 

With the appearance of the rash the patient will 
probably become quite ill, the tongue will be heavily 
coated, the tonsils swollen, and the coryza worse. 
These symptoms abate as the rash fades, and when 
no complications ensue convalescence is generally 
rapid. 

The Temperature. — The temperature rises to 
102 °- 1 04 ° F. on the first day. It remits one or two 
degrees during the next two days. It rises again 
when the rash appears, and remains up till the rash 
fades, when it falls, sometimes by crisis, at other times 
by lysis. 

Complications. — The possible complications are 
broncho-pneumonia, laryngitis, otitis media, chronic 
conjunctivitis, fatal epistaxis, purpura. 

Nursing. — The general nursing is the same as in 



364 Practical Nursing 

all other fevers. Isolation should be continued from 
the invasion until desquamation ceases. The eyes 
require special attention. They must be shaded from 
the light and cleansed as often as necessary (boric 
acid 2% is always safe to use if the doctor gives 
no special prescription). The patient should not be 
allowed to read, even during convalescence. The nose, 
mouth, and throat must also be constantly cleansed, 
otitis media being generally the result of improper 
care of the same. The room must be kept well venti- 
lated and at a uniform temperature, 68° F. All 
draughts must be guarded against, especially during 
convalescence. A sudden chilling of the skin or cold 
throws extra work upon the kidneys and may cause 
a nephritis. 

German Measles (Rubella) 

The specific cause of German measles is unknown. 
It is an infectious disease and is by some authorities 
considered contagious. Though it resembles measles 
in many points, it bears pathologically no relation 
to it. 

Incubation. — The period of incubation is ten to 
fourteen days. 

Symptoms. — German measles is marked by enlarge- 
ment of the cervical lymphatic glands, and, in some 
cases, of those of the axilla and groins also. The other 
symptoms resemble those of measles, but are milder. 

Eruption. — There are two types of eruption, one 
being somewhat like that of scarlet fever, and the other 
like that of measles, except that it never takes a cres- 
cent form. The rash appears about the second day, 
first behind the ears and around the mouth, whence 
it spreads to the chest and over the body. It lasts 



A Synopsis of Important Diseases 365 

two or three days and may be followed by a slight 
desquamation. 

Temperature. — Unless there is more than the ordi- 
nary degree of inflammation of the lymphatics, the 
temperature seldom rises above ioo° or ioi° F., and 
it rarely persists longer than one or two days. 

Nursixg. — The patient should be kept quiet — not 
necessarily in bed — in a uniformly heated roc-m. Iso- 
lation should be continued till desquamation ceases, 
which is usually after ten to fourteen days. A thor- 
ough airing of the room and disinfection of utensils 
and clothing are all that is necessary in the way of 
disinfection at the end of the case. 

Meningitis. Cerebro-Spinal Meningitis (Spotted Fever) 

This is an infectious disease caused by trie meningo- 
coccus or diplococcus intracellularis. It is charac- 
terised by an inflammation of the cerebral and spinal 
meninges. 

Predisposing Causes. — The predisposing causes 
of meningitis are: other diseases, such as diphtheria, 
influenza, measles, and pneumonia, general debility, 
exposure to wet and cold. 

Incubation. — The period of incubation is uncertain. 

Symptoms. — The onset is generally sudden, begin- 
ning with a chill or convulsion, and followed by a rise 
of temperature, intense headache, projectile vomiting, 
photophobia, and strabismus. There is often delirium, 
even in the early stages of the disease. The patient 
may be exceedingly restless, emitting from time 
+0 time a sharp typical cry. The muscles of the neck 
become rigid, causing a retraction of the head. The 
patient often lies with the thighs flexed, so that they 



366 Practical Nursing 

form a right angle with the trunk, and the legs cannot 
be extended. This is known as Kernig's sign. There 
is generally hyperaesthesia of the skin and muscles. 
Convulsions may occur at any time during the disease. 
Petechiae and herpes are common, and at times there 
is general purpura. 1 Lumbar puncture usually shows 
an increased amount of fluid from the spinal canal, 
and the specific germ is often found therein. 

The Temperature. — The temperature varies 
greatly in different types of the disease. Its course is 
very irregular. In mild cases there will be little rise 
of temperature, and the other symptoms will be 
correspondingly slight. Recovery generally takes 
place in a few days. In abortive cases the initial 
symptoms are similar to severe cases, but they cease 
suddenly after a few days. In intermittent cases the 
temperature periodically falls and other symptoms 
abate, but the improvement only lasts a few hours 
or days. Chronic cases sometimes drag on for 
months, with frequent exacerbations and remissions. 
The patient may be continually restless or may lie 
in a state of semi-coma. Such cases are generally 
fatal. Malignant cases end fatally in from twelve 
hours to three days, death being due to toxaemia. 

Complications. — The possible complications are 
pneumonia, pleurisy, endocarditis, pericarditis, otitis 
media (followed by deafness) , optic neuritis and other 
inflammations of the eye that may cause permanent 
blindness, paralysis, and mental feebleness. In chil- 
dren, growth may be stunted, and chronic hydroceph- 
alus may appear even some weeks after convalescence. 

The other most common forms of meningitis are : 

i The name of spotted fever was formerly given to menin- 
gitis on account of the purpura often associated with it. 



A Synopsis of Important Diseases 367 

purulent meningitis, in which the inflammation is 
generally due to infection from otitis media, mas- 
toiditis, etc.; and tubercular meningitis, in which it 
is due to the tubercle bacilli. 

Nursing. — The patient should be kept quiet in a 
cool, 65 ° F., dark room. All discharges from the 
throat and mouth should be disinfected, and gauze, 
which must be burnt after use, should take the place 
of handkerchiefs. Feeding, which frequently must 
be done by nasal gavage, is of the utmost importance. 

Mumps (Infectious Parotitis) 

The specific cause of mumps is unknown. It is con- 
tagious from onset until after the swelling entirely 
disappears. 

Incubation. — The period of incubation is two to 
three weeks. 

Symptoms. — The symptoms are headache, nausea, 
pain, and swelling of the parotid glands. 

Temperature. — In mild cases the temperature 
varies between ioo° and 102 ° F.; in severe cases it 
may go as high as 105 ° F. 

When no complications ensue, recovery is generally 
complete in a week or ten days. 

Complications. — Earache, otitis media. The gen- 
erative organs are sometimes affected. Meningitis 
has occurred and also suppuration of the parotid 
gland, but the last three complications are rare. 

Nursing. — The patient should be isolated till all 
symptoms subside, and kept in bed while there is any 
fever. The frequent cleansing of the mouth is of the 
utmost importance, as the majority of cases in which 
otitis media develops may be traced to neglect in this 
matter. 



368 Practical Nursing 

Plague 

The specific cause of the plague is the bacillus pestis. 
It occurs in the buboes, urine, faeces, and blood. It is 
frequently found in the soil, in countries where the 
disease is prevalent. The disease attacks the lower 
animals, especially rats, and they, flies and fleas, are 
often the means of spreading it. It can be contracted 
through the respiratory and alimentary tract, but 
inoculation is the most common method of infection. 

Predisposing Causes. — The predisposing causes 
are diet, crowding, and lack of proper nourishment. 

Incubation. — The period of incubation is three to 
seven days. 

Varieties. — There are three varieties of the disease: 
the bubonic, the pneumonic, and the septicsemic. 

The Bubonic — The bubonic type is the most 
common. 

Symptoms. — The onset is abrupt. There is a chill, 
followed by a fever io2°-io6° F., and leucocytosis. 
The prostration is marked. The buboes appear from 
the second to the fifth day. The axillary, femoral, 
and inguinal nodes are the ones usually attacked. 
These buboes may soften and resolve, they may sup- 
purate and break through the skin, or they may be- 
come gangrenous. 

The Temperature. — The fever remits soon after the 
appearance of the buboes, but it quickly rises again, 
remains high for about a week, and finally falls by 
lysis. 

Prognosis. — The mortality is about 50 per cent. 

The Pneumonic Type. — In the pneumonic type 
there is a broncho-pneumonia and the bacillus pestis 
is found in the blood and sputum. 



A Synopsis of Important Diseases 3 6 9 

Prognosis. — The mortality is 95 per cent. 

Septicemic Type. — In the septicemic type, there 
are no buboes, but the entire system is poisoned by 
the infection. 

Prognosis. — Many patients collapse and die in a few 
hours, while others live for two or three days. The 
mortality is 80 per cent. 

Nursing. — The buboes, unless they suppurate, are 
generally incised. The after-treatment is then the 
same as for any suppurating wound. Rigid isolation, 
cleanliness, and fresh air are of primary importance. 
The febrile symptoms are treated as in any other case 
of fever. The tendency to sudden collapse must be 
remembered, and treatment for it started at the first 
symptoms. 

Pneumonia 

Lobar pneumonia is an infectious disease caused by 
a specific organism, "the micrococcus or diplococcus 
lanceolatus or bacillus pneumoniae (pneumococcus)," 
which produces an acute inflammation and consolida- 
tion of the lung tissue and a severe constitutional 
toxaemia. One or both lungs may be affected, or only 
a portion of one or more of the lobes. When both 
lungs are affected it is called "double pneumonia." 

Predisposing Causes. — Cold, the inhalation of 
smoke, of gas, and sometimes of ether, a too long con- 
tinuance in one position, any injury to the chest, and 
indeed any factor which tends to irritate the lung 
substance, may predispose to pneumonia. Pneumo- 
nia is also likely to complicate accidents which neces- 
sitate the performance of artificial respiration, and it 
frequently complicates or follows other diseases. 
Alcoholic habitues are particularly subject to pneu- 
24 



37° Practical Nursing 

monia, and the prognosis in such cases is very 
unfavourable. 

Symptoms. — The disease generally comes on sud- 
denly with a severe chill, followed by a rise of tem- 
perature to io4°-io5° F., increased respiration, and 
a cough accompanied by pain. The face is flushed, 
particularly the cheeks, the nostrilla dilate with each 
inspiration, and herpes is generally present, especially 
around the lips. 

Sputum. — The state of the sputum is also of diag- 
nostic value in pneumonia. During the first stage it 
is a frothy serous fluid mixed with mucus. But in 
the second stage it becomes extremely tenacious and 
streaked with blood. In some cases the sputum is 
often a reddish-brown colour — a prune- juice sputum. 
This is always a grave indication. When resolution 
begins, the expectoration gradually ceases to be blood- 
streaked, and becomes at first more abundant, and 
then gradually less in quantity. 

Stages. — There are four distinct stages in the 
course of the disease: (i) onset, (2) fastigium, (3) 
crisis or lysis, (4) convalescence. The first three are 
also known as engorgement, red hepatisation (or con- 
solidation), and grey hepatisation (or resolution), 
respectively. In the first stage, the lung tissue is a 
deep red colour, and firmer and more solid than the 
normal lung. It still crepitates, though indistinctly. 
In the second stage, the portion of the lung involved 
becomes solid and airless. The third stage is marked 
by the gradual softening of the exudate and the return 
of the tissue to its normal state. 

Temperature. — The temperature rises immediately 
after the initial chill to about 104 or 105 F., and 
remains there, with but slight remission, till resolu- 



A Synopsis of Important Diseases 37 l 

tion takes place. This happens, as a rule, either on 
the third, fifth, seventh, or ninth day. In the majority 
of cases it then falls by crisis. Occasionally it falls 
by lysis, taking three or four days to reach the normal 
line. If it remains continuously high for a much 
longer period, it may be due to complications or to 
delayed resolution. 

Pulse. — In pneumonia the pulse is full and bound- 
ing, ranging from 96 ° to 120 or 140°. There is 
perhaps no disease in which it is more important to 
note the pulse carefully, since death occurs in a large 
number of cases from heart failure. 

Respirations. — The respirations are shallow and 
rapid, and there is always more or less dyspnoea. In- 
creasing respiration and cyanosis are of serious import. 

Leucocytosis. — The leucocytosis is high — 25,000 
to 35,000. 

Tympanites. — Tympanites in pneumonia is due 
not only to decreased peristaltic action, but also to 
the excess of carbonic gas in the blood, caused by its 
lack of proper oxygenation. 

Complications. — The most common complications 
of pneumonia are pleurisy, endocarditis, pericarditis, 
oedema of the lung, and, in alcoholic patients, delirium 
tremens. 

Sequels. — The most frequent sequelae are empy- 
ema, abscess of the lung, and gangrene of the lung. 

Broncho-Pneumonia 

Broncho-pneumonia, in which the bronchi are af- 
fected as well as the lung, is the most frequent form 
of pneumonia in children and the aged. It is even 
more liable to prove fatal than lobar pneumonia, and 



37 2 Practical Nursing 

complications, such as abscess of the lung and gan- 
grene, are more likely to follow. 

Embolic Pneumonia 

Embolic pneumonia is due to embolism of the ves- 
sels of the lung. 

Hypostatic Pneumonia 

Hypostatic Pneumonia is generally due to a failing 
heart. It may also be caused by a too long contin- 
uance in one position. 

Inhalation Pneumonia 

Inhalation pneumonia is due to the inhalation of 
smoke, gas, etc., or to the introduction of fluid or 
vomitus into the trachea. 

Migratory Pneumonia 

Migratory pneumonia affects one lobe after the 
other. 

Septic Pneumonia 

Septic pneumonia is due to absorption of septic 
material. 

Nursing. — In pneumonia, the nursing is directed 
principally toward making the patient comfortable 
in the most restful position that will allow free play 
of all the muscles of the chest. Therefore he should 
be kept perfectly quiet, being permitted no conversa- 
tion or exertion that may agitate or excite to effort, 
and thus increase the respiration and heart action. 
After coughing, he should be urged to expel the spu- 



A Synopsis of Important Diseases 373 

turn, using a gauze handkerchief. This is often a 
difficult matter, since the tenacious character of the 
sputum makes it cling to the lips and tongue. The 
nurse must remove it frequently with gauze and a 
wooden spatula, and, as all expectoration contains 
the germs of the disease, it must be burned at once. 
Delirious or semi-conscious patients often expecto- 
rate upon the bed-clothes, walls, and floor, 1 or into the 
face of the nurse. The nurse may guard against the 
last by turning her head aside. The bowels must be 
kept free and tympanites relieved by the tube or tur- 
pentine stupe. The inflammation of the lungs is by 
some physicians treated with topical applications, 
i. e., hot poultices, ice compresses, ice poultices, cold 
packs. Others employ the fresh-air treatment, which 
consists in treating the patient, whose body is well 
protected from the cold, in the open air, or placing him 
directly in front of an open window, allowing the air 
to blow constantly through the room regardless of 
atmospheric temperature. Restraint, when it be- 
comes necessary, should not interfere with the move- 
ments of the chest. The hands and feet, however, 
must be made absolutely secure, especially in the case 
of alcoholic pneumonia, when the patient is apt to be 
violent in the extreme. Heart failure and oedema of 
the lungs (accompanied by a dusky hue and labored 
respirations) are constantly to be watched for and 
reported. Heart stimulants are usually called for, 
when the pulse becomes feeble, rapid, and irregular. 
For oedema, dry cupping of the anterior and posterior 
chest is sometimes ordered, the cups being applied 
very rapidly and allowed to remain on only a few 

1 When this occurs, the bed-clothes, walls, and floor should, 
of course, be disinfected . 



374 Practical Nursing 

seconds. The sudden drop of temperature to sub- 
normal which follows the crisis of pneumonia is some- 
times alarming and calls for prompt action. Extra 
blankets, hot bottles, and a hot drink are remedies any 
one may use with safety. 

Rheumatic Fever (Acute Articular Rheumatism) 

Rheumatic fever is an acute infectious, contagious 
disease caused, it is believed, by a streptococcus. It 
is usually characterised by poly-arthritis and inflam- 
mation of the fibrous membrane of the joints, result- 
ing in pain and swelling of the same. 

Predisposing Causes. — The predisposing causes 
are exposure to cold and damp, and lack of proper 
nourishment. 

Symptoms. — The disease sometimes sets in abruptly 
but, as a rule, it is preceded by a slight malaise, pain 
in the joints, and sore throat. The affected joints 
become red, swollen, and painful. There are apt to 
be profuse sweats, and the perspiration has a strong 
sour odour and acid reaction, owing probably to the 
large amount of lactic acid in the system. 

Eruption. — Sudamina, or a red miliary rash is 
often present, and sometimes purpura. 

Urine. — The urine is scanty, highly coloured, 
and strongly acid. 

Temperature. — The temperature varies from 
io2° to 104 F., with marked remissions. Defer- 
vescence is gradual. 

Pulse. — The pulse is generally frequent and 
weak. Its character must at all times during the 
disease be carefully noted, as cardiac complications 
are likely to occur. 



A Synopsis of Important Diseases 375 

There will be a marked leucocytosis. 

Course. — The attack may last for weeks. The 
swelling often disappears for a day or two, and then 
a relapse occurs. 

Complications. — The possible complications are 
endocarditis, myocarditis, pericarditis, erythemas 
(especially erythema nodosum, or purpura), tonsil- 
litis, and anaemia. 

Diet. — While the temperature is high, milk and 
gruels are given, but meat broths are seldom allowed. 
When the fever falls, the following articles are allowed: 
vegetable soups, farinacious puddings, unsweetened 
or sweetened with saccharine, unsweetened milk toast, 
and, gradually, fresh vegetables, fish, eggs, and 
chicken. Other meats are generally withheld for 
some time, as they increase the formation of lactic 
acid; also sweets, fermented liquors, and sweet wines. 

Nursing. — The general treatment is the same as 
in all fevers. Local applications are generally or- 
dered, and care must be taken in applying the same 
to move the extremities as gently and as little as pos- 
sible, for every movement is painful in the extreme. 
The extremities are often immobilised by the applica- 
tion of splints, sand-bags, or pillows, and they should 
be protected by '"cradles" from the weight of the bed- 
clothes. Flannel sheets, owing to the excessive per- 
spiration, are often preferred to cotton, and unless it 
is too painful for the patient, they should be fre- 
quently changed. Move the patient as little as possible, 
and never allow him to exert himself, thereby avoiding 
unnecessary strain upon the heart. Be careful not to 
jar the bed nor to allow any sudden noise such as 
slamming of doors or window shutters to startle the 
patient. 



37 6 Practical Nursing 

Scarlet Fever (Scarlatina) 

Mallory has found certain bodies in and between 
the epithelial cells of the skin in scarlet- fever patients 
which he suggests may be specific protozoan bodies. 
Infection is principally spread by means of the des- 
quamated epithelium. Scarlet fever is contagious 
from the onset to the end of desquamation. The 
germ is long-lived and hard to destroy. Clothing 
worn by a scarlet -fever patient has been known to 
cause infection years later. 

Incubation. — The period of incubation varies from 
one to ten days. 

Symptoms. — The onset is sudden. Young children 
often have convulsions, older children and adults a 
chill. In other cases, the secondary symptoms, viz; 
vomiting, sore throat, headache, and abrupt fever, 
103 to 105 F., come on immediately. 

Eruption. — The eruption, which appears within 
eighteen to thirty-six hours, comes out first on the 
neck, chest, and back, and then spreads rapidly over 
the entire body and the upper part of the face. The 
rash in scarlet fever rarely involves the chin and the 
outside of the mouth. It is, however, very apt to be 
found in quite thick patches in the pharynx. The 
eruption consists first of pale red points, which, in a 
few hours becomes confluent, producing a uniformly 
red surface which continues for four or five days. At 
the end of this time it fades, and is followed a few 
days later by desquamation, which continues from one 
to three weeks. 

Tongue. — The condition of the tongue is of 
diagnostic value in scarlet fever. It is at first white 
and coated, but in a day or two the fungiform papillse 



A Synopsis of Important Diseases 377 

become red and swollen, producing what is called the 
' ' strawberry tongue. ' ' 

Temperature. — The temperature remains high 
for two or three days. Then it falls by slow lysis, 
lasting to the eighth or ninth day. A leucocytosis is 
present. 

Complications. — The possible complications are 
oedema of the glottis, suppuration of the lymph-nodes 
in the neck, adenitis, cellulitis of the neck, purulent 
otitis media, acute endocarditis, nephritis, and 
arthritis. There is a false membrane covering the 
tonsils as in diphtheria, but the Klebs-Lomer bacilli 
may or may not be present. 

Sequels. — The possible sequelae are chronic endo- 
carditis, chronic nephritis, deafness, paralysis, and 
blindness — from iritis or neuro-retinitis. 

Prognosis. — Healthy children, when well cared for, 
generally recover, but sequelae may follow. 

Immunity. One attack generally renders a person 
immune. 

Nature of Desquamation. — The desquamation 
in scarlet fever differs from that of any other disease, 
in that the superficial skin can be peeled in long strips. 

Nursing. — The general treatment is the same as 
in all febrile diseases. Strict quarantine must be ob- 
served from the onset till desquamation ceases. This 
generally means six to eight weeks, the forty-day limit 
being usually set. The room should be kept well 
ventilated, but free from draughts, and at a uniform 
temperature, 68° F. The urine should always be 
measured, and any change in its amount or appear- 
ance reported immediately to the physician. The 
care of the mouth and throat is of the utmost impor- 
tance. Bathe and anoint the skin daily during des- 



37 8 Practical Nursing 

quamation, being careful not to clog the glands with 
the ointment. Report carefully even insignificant 
symptoms. 

Septic Diseases 

Septicemia. — Septicaemia is a disease caused by 
certain species of bacteria, which enter the body 
through wounds or abrasions in the skin or mucous 
membranes. They cause suppuration of the tissue 
and the formation of toxins, which, being absorbed 
by the blood or lymph, poison the system. The 
uterus after labor or abortion is a frequent site of 
infection. Sepsis may also follow suppurative dis- 
eases of any of the organs of the body. The micro- 
organisms most commonly associated with this 
condition are the streptococcus, and staphylococcus 
of suppuration, and, sometimes, the pneumococcus, 
meningococcus, gonococcus, etc. 

Symptoms. — Twelve hours to two or three days 
after the infection there is a chill, the temperature 
rising during the chill to 104 or 105 F. There will 
be nausea, headache, anorexia, and all other febrile 
symptoms. Leucocytosis, is pronounced. In mild 
cases, under proper treatment, the symptoms may 
subside after a few days. In severe cases, the patient 
quickly passes into a typhoidal condition. The mind 
may remain clear or there may be delirium. The 
temperature remains persistently high, the surface of 
the skin is often cold and covered with perspiration, 
cyanosis is often marked, and the face is pinched and 
drawn. The discharge from the wound is diminished, 
but the tissues are brown and dry, and there is a foul, 
fetid odour. In cases of puerperal sepsis, the lochia 
becomes exceedingly foul. In progressive sepsis the 



A Synopsis of Important Diseases 379 

symptoms are much the same, but come on more 
slowly, the temperature is irregular, and there is a 
continual series of chills, fever, and sweating. Various 
eruptions, such as erythema and petechias, often 
appear. 

Nursing. — The treatment is the same as in all surgi- 
cal and febrile cases. When the patient recovers, 
convalescence is liable to be long and tedious. Fresh 
air and nourishing food are then two of the most essen- 
tial things to be considered in the nursing. 

Pyemia. — Pyaemia is caused by the same organ- 
isms as septicaemia, but, owing to the entrance of the 
bacteria into the veins, thrombi form and embolism 
results. The emboli, being septic, break down and 
form abscess cavities wherever they lodge. 

The formation of an abscess is generally marked by 
a chill. This may occur daily, or even more fre- 
quently. The temperature falls before the chill and 
rises during it, mounting, sometimes, even as high as 
107 ° F. The other symptoms are those of septicaemia 
in a marked degree. 

The prognosis is very bad, death usually resulting 
within a few days. 

Malignant Endocarditis. — Malignant endocar- 
ditis is an inflammation of the endocardium caused 
by one or another of the pyogenic bacteria. 

Symptoms. — The symptoms are those of a severe 
endocarditis and sepsis combined. 

Small-Pox (Variola) 

The specific germ of small-pox is supposed to be a 
protozoan. It is an extremely virulent and highly 
contagious disease, characterised by a high fever 
and typical eruption. 



380 Practical Nursing 

Incubation. — The period of incubation is one to 
three weeks, usually twelve days. 

Symptoms. — The symptoms are a sudden intense 
fever, io3°-io5° F., that may or may not be preceded 
by a chill, or in children by a convulsion ; severe head- 
ache; intense pain in the lumbar region and extremi- 
ties; vomiting; and, often, delirium. 

Eruption. — The eruption proper appears on the 
third day, but it is often preceded by an initial roseola 
that resembles the rash of scarlet fever. 

The typical eruption has five stages — the macule, 
the vesicle, the pustule, the crust, and the cicatrix. 
Each of the first two stages continues for three days. 
1. A small, hard lump is felt under the skin. 2. A 
vesicle forms above the skin. 3. The serous fluid 
of the vesicle turns to pus. The duration of this 
third stage depends upon the severity of the disease. 
It is followed by the formation over the surface of 
each vesicle of crusts, the nature of which also de- 
pends upon the severity of the disease. In mild cases 
they are little more than scales of skin, while in others 
they are of a thick crusty character and leave a deep 
pitting when they drop off, as they generally do by 
the end of the third or fourth week. Owing to the 
improved treatment of the present day, the cicatrix 
is not now either as deep or as permanent as for- 
merly. During the eruption there is always more 
or less burning and itching of the skin. 

The eruption is classed, according to its nature, as 
discrete, confluent, or hemorrhagic. In the first, 
the pustules remain separated, and dry up by the 
thirteenth or fifteenth day. In the confluent type, 
the pustules increase in size and run together. The 
swelling around them is more marked than in the dis- 



A Synopsis of Important Diseases 381 

crete type, as are also the pain and the itching. The 
patient often dies of sepsis in a few days. If he sur- 
vives, the pustules dry up during the third week and 
the resulting crusts will probably be off by the end of 
the fourth. There are two varieties of the haemor- 
rhagic type. 

1. Purpura variolosa. The onset is severe, there 
is bleeding from all the mucous membranes, and the 
patient often dies before the appearance of the rash. 

2. Variola pustulosa hemorrhagica. The erup- 
tions are of the confluent type with haemorrhage into 
the pustules. These cases seldom recover. 

Temperature. — The temperature rises rapidly 
after the initial chill to 103 °- 105 ° F., and remains 
high until the eruption appears. It then falls, re- 
maining lower (99°-ioi° F.), till the pustules form, 
when it gradually rises, reaching its height about the 
ninth day. In mild cases lysis then begins, but in 
severe cases the temperature will remain high for some 
days longer. The leucocytosis is high. 

Complications. — The possible complications are 
septicaemia, pyaemia, empyema, myocarditis, nephri- 
tis, pharyngitis, abscesses, and cellulitis of the skin 
and subcutaneous tissue. 

Varioloid. — Varioloid is a mild form of small-pox, 
which attacks those who have been vaccinated. The 
invasion is much the same as in small-pox, but the 
symptoms are all milder. The eruption is less in 
quantity and degree, and the secondary fever is 
slight. 

Vaccination (see Chapter XX). — Vaccination 
should be performed in infancy; again, about the 
seventh year; in early adult life: and during epidem- 
ics, or after exposure to small-pox, when such 



382 Practical Nursing 

exposure occurs more than five or seven years after the 
last vaccination. 

Nursing. — The strictest quarantine must be ob- 
served from the onset till the falling of the last crust. 
The pus from the sores should be cleansed by sponging 
with disinfectants. Itching can be much relieved 
by frequent sponging and by soaking the crusts in 
oil or vaseline. To prevent pitting, the patient must 
be restrained from scratching himself. This is best 
accomplished by encasing his hands in gloves, tying 
his wrists so that the face cannot be reached, and fit- 
ting a mask of lint over his face. The mask and gloves 
are kept constantly moist with different antiseptic 
solutions or ointments. 

The eyes should be irrigated every two hours, and 
the mouth, as in all contagious cases, cleansed after 
and before each feeding. Fresh air and cleanliness 
are of more than ordinary importance. 

Syphilis 

Syphilis is a chronic infectious and constitutional 
disease transmitted by inoculation. It enters the 
system by means of the blood-vessels and lymphatics. 
It first attacks the connective tissues, but it may, 
during its course, attack every tissue and organ of 
the body. 

It may be inherited or acquired. When the disease 
is inherited, the symptoms may appear immediately, 
but more commonly they come on about the second 
month. The skull shows prominent frontal eminences, 
and there is thickening around the anterior fontanel, 
A rash appears, usually erythematous in character, 
but sometimes papular or pustular. Ulcers will form 



A Synopsis of Important Diseases 383 

on the mucous membrane. There will probably be 
a more or less purulent discharge from the nose, eyes, 
or ears, and in female children from the vagina. The 
child invariably has the snuffles, is thin, marasmic, and 
looks old. During this stage it can infect others. 

When such children live they are liable to be epi- 
leptic, idiotic, or hydrocephalic. When the teeth 
appear, the upper central incisors are small, conical, 
and notched at the end (" Hutchinson teeth"). There 
will probably be keratitis, iritis, or deafness. Gum- 
mata may form in the viscera, and there may be peri- 
osteal nodes on the long bones. 

Syphilis may be acquired by direct contact with 
some one suffering from it, or by using linen, dishes, 
or utensils used by such patients and not disinfected. 
The disease is infectious in the primary and secondary 
stages. The germ is in the blood, and in secretions 
from sores and mucous patches; these, therefore, are 
the source of infection. Xurses attending obstetrical 
or gynaecological cases complicated by syphilis are 
particularly liable to infection unless they exercise 
the greatest care. 

Incubation. — The period of incubation is about 
three weeks. 

Symptoms. — The primary stage lasts about six 
weeks. There are no constitutional symptoms, but 
the glands (particularly those of the inguinal region) 
become enlarged, and the chancre or initial lesion 
appears at the point of infection. 

The secondary stage may continue either for a few 

weeks or for two or three years. It is marked by 

eruptions of various types : mucous patches 1 upon the 

» The tissue is moist, swollen, and covered with a greyish 
film. 



384 Practical Nursing 

mucous membranes of the mouth, nose, arms, or 
vulva 1 ; and various constitutional symptoms, such as 
slight fever, general malaise, headache, disturbance 
of the digestive organs, anaemia, iritis (and other in- 
flammations of the eye), otitis media, deafness, pain 
in the bones, particularly at night, and a falling of the 
hair. 

The third or tertiary stage does not always begin 
immediately after the symptoms of the second abate, 
and with proper treatment it may sometimes be 
avoided. There are various skin lesions. Of these, 
the papillomata and indolent ulcers with scaly crusts 
that after healing leave deep scars are especially com- 
mon. Infection can be contracted from the discharge 
of these ulcers, otherwise there is no danger of con- 
tagion in the tertiary stage. Gummata may appear 
in any part of the body. Periosteal nodes form on the 
bones, especially on the shins. The bones of the nose 
may necrose, causing a sinking in of the bridge of the 
nose. There may be ulceration and necrosis of the 
laryngeal cartilages and vocal cords, with perfora- 
tion of the hard or soft palate. 

Nursing. — During the contagious stages, the dis- 
infection usual in other infectious diseases should be 
carried out, and nurses should be particularly careful 
of their hands. Infection is frequently acquired by 
failure in this respect. Rubber gloves should be worn 
when giving inunctions, doing dressings, douching, etc. 
Mercury and potassium are the drugs most frequently 
used in this disease. (For the giving of inunction, 
see Chapter X. For calomel fumigation, see Chapter 
XV.) 

1 A very large per cent, of blindness is due to infection from 
mucous patches of the vulva during delivery. 



A Synopsis of Important Diseases 3 8 5 

Tetanus 

The specific cause of tetanus is the bacillus tetani, 
which enters the body through the wounds or abra- 
sions in the skin and mucous membrane. Outside 
the body, it is most commonly found in the soil, in 
manure, and in damp cellars. It has also been found 
in the intestines of herbivora. In the human body, 
it is usually only found in and around the point of 
entrance. 

Ixcubatiox. — The period of incubation is one day 
to three weeks, usually two weeks. 

Symptoms. — The onset is gradual. There is a grow- 
ing rigidity of the muscles of the neck and jaw, which 
spreads slowly to the trunk and legs. The arms are 
seldom involved. As the rigidity increases, spasmodic 
contractions of the muscles develop and increase in 
intensity, till the body at times rests on the head and 
heels. Severe clonic convulsions are often present. 
Noises, jarring the bed, or touching the patient will 
often produce these. 

Temperature. — The temperature is variable. In 
mild cases there is sometimes only a slight elevation. 
Ordinarily it runs between 103 and 105 F., but in 
some cases it may be higher, and is frequently no° F. 
and over before death. 

Treatment. — The wound is either cauterised or 
the surrounding tissue excised. Bromides or chloral 
are generally given, and the convulsions are controlled 
by the use of chloroform. 

Nursing. — Absolute quiet is one of the most essen- 
tial specific points in the nursing. The patient should 
be placed in a darkened room. Either nasal or rectal 
feeding is resorted to when necessary, and to prevent 

25 



386 Practical Nursing 

convulsions it is frequently necessary to keep the 
patient under the influence of chloroform during the 
process. 

Tuberculosis 

The specific cause of tuberculosis is the bacillus 
tuberculosis. 1 The germ is found in the lesions and 
in the discharge from the seat of infection. Any part 
of the body may be affected. In children, the most 
frequent sites of the disease are the bones, joints, 
lymph-nodes, peritoneum, and meninges; in adults, 
the lungs. Other, though less common, seats of the 
disease are the lymphatic system, the nervous system, 
the alimentary tract, the genito-urinary tract, and 
the skin. 

The germ enters the body with the breath or with 
contaminated food supplies. Milk is a frequent source 
of infection. The bacillus is long-lived and can be 
carried to great distances when discharges containing 
it are allowed to become dry and scatter. It is, how- 
ever, easily killed: exposure to the direct rays of the 
sun will act as a germicide in six hours, and three min- 
utes' exposure to the action of boiling water will have 
the same effect. 

In conjunction with the specific symptoms, tuber- 
culosis is diagnosed by the finding of the germs in the 
discharge from the affected part. When the symp- 
toms are doubtful, tuberculin is sometimes injected 
hypodermatically. If the patient has tuberculosis, 
the injection is generally followed by a rise of temper- 
ature within twenty- four hours. 

Unsanitary conditions, lack of nourishing food, and 

1 Discovered by Koch in 1881. 



A Synopsis of Important Diseases 3 8 7 

general debility are the most common predisposing 
causes of the disease. 

Acute General Miliary Tuberculosis. — Acute 
general miliary tuberculosis generally occurs second- 
ary to previous tuberculosis, either active or latent. 
There are three types — the typhoid, the pulmonary, 
and the meningeal. 

i. In the typhoid type, there is generally toxaemia, 
resembling typhoid, accompanied by bronchitis and 
cyanosis. The temperature is more irregular than in 
typhoid, and the rose spots and abdominal symptoms 
are lacking. 

2. Pulmonary type. The pulmonary type gener- 
ally occurs in the course of a chronic pulmonary tuber- 
culosis or an infectious disease. The symptoms are 
those of an acute tubercular broncho-pneumonia. 
The patient generally dies in a few weeks. 

3. The meningeal type (tubercular meningitis). 
This type resembles cerebro-spinal meningitis in many 
respects, but the head is as a rule less retracted, the 
course of the disease is slower, and the fever moderate 
and irregular. Such patients rarely recover. 

Pulmonary Tuberculosis (Phthisis). — Pulmo- 
nary tuberculosis may be either chronic or acute. The 
symptoms are much the same in both, but develop 
more rapidly and with greater severity in the acute 
form. If the course of the disease is not immediately 
checked, it will probably end fatally in a few weeks. 
The chronic form may drag on for years, or, if taken 
in time, may occasionally, under proper treatment 
and suitable surroundings; be partially or even en- 
tirely checked. 

Symptoms. — The symptoms of pulmonary tuber- 
culosis are anorexia; profuse perspiration, especially 



388 Practical Nursing 

at night; progressive emaciation and weakness; a 
short hacking cough, sometimes accompanied with 
pain in the lung, and a muco-purulent sputum con- 
taining the specific germ; a hectic flushing of the 
cheeks, particularly towards evening; anaemia; oc- 
casional attacks of diarrhoea and vomiting. The 
temperature generally runs a typical course, being 
comparatively low in the morning and rising towards 
evening. The pulse is soft and rapid. As cavities 
form in the lung the symptoms increase in severity; 
there are apt to be chills and haemoptysis. The pa- 
tient is hopeful of recovery till the very last. 

Acute Pneumonic Phthisis. — Acute pneumonic 
phthisis begins much like a lobar pneumonia, but de- 
fervescence fails to take place. Night-sweats and other 
tubercular symptoms come on, and the tubercular 
bacilli will soon be found in the sputum. Death occurs 
in the majority of cases in from two to eight 
weeks; in others, the symptoms abate and a chronic 
phthisis ensues. 

Nursing. — Careful disinfection of the specific dis- 
charge is necessary to avoid the spreading of the 
disease. Disinfection of the bed-clothes and, in ad- 
vanced pulmonary tuberculosis, of all dishes used for 
eating and drinking is advisable. 

The sputum is best received in sputum cups that 
can be burned daily. When these cannot be obtained, 
porcelain cups, half filled with formaldehyde solution 
2 %, or carbolic solution i : 40 can be used. These cups 
must be kept covered, emptied frequently, and boiled 
daily. Pieces of gauze and old linen that can be 
burned after use are preferable to handkerchiefs. A 
constant supply of fresh flowing air, cleanliness, and 
nourishing food are the other most important points 



A Synopsis of Important Diseases 389 

in the nursing of tuberculosis. When possible, the 
patient should be kept out-of-doors all day, and even 
all night when a sheltered place can be provided. 
When not, the window of the sleeping-room must be 
kept open and the patient's bed placed so that he will 
get the full benefit of the incoming air; but he must 
be protected from draughts, and kept well covered 
and warm. The open-air treatment is so well known 
that it needs no discussion here. When he is not too 
weak, a small amount of exercise, regulated according 
to his strength, is deemed advisable. 

Owing to the tuberculosis patient's lack of appetite, 
the dainty serving of food is of more than usual 
importance; and, as indigestion and lack of proper 
assimilation of food are apt to complicate all forms of 
tuberculosis, it is best served in small quantities and 
often. 

Diet. — In cases of severe indigestion, liquid diet 
is generally given. At other times, even when there 
is continued temperature, a generous diet is usually 
provided. Scraped beef, raw or slightly browned in 
the oven, is excellent. Milk and eggs are both very 
important factors in the diet. Fresh meat of all kinds, 
fresh fish, vegetables, cereals, and fruit are all allowed. 
Fats, when the patient can digest them, are also good. 
But sweets and richly cooked or highly seasoned foods 
are to be avoided. Alcohol, in the form of strong 
spirits, except in flavouring for egg-noggs, is seldom 
gu~en; but claret, Burgundy, ale, and porter are fre- 
quently allowed. 

Typhoid Fever (Enteric Fever) 

Etiology. — Typhoid fever is an infectious disease 
caused by a germ called " Elberth's bacillus typho 



39° Practical Nursing 

sus." In autopsy it has been found in the lymphoid 
tissue of the intestines, the mesenteric glands, the 
spleen, liver, and kidneys. The poison is given off 
principally in the faeces, but the germ is also often 
present in the urine, blood, and the pus of abscesses 
when such complicate the disease. 

Infection is by mouth. Typhoid can be transmitted 
by anything that has come in contact with any of the 
discharges containing the germ, provided the object 
has not been properly disinfected. 

Lesions. — The principal seat of inflammation is 
the ileum, particularly that portion in which the 
glands of Peyer (" Peyer's patches") are situated. 

Incubation. — The period of incubation is two to 
three weeks. 

Primary Symptoms. — The primary symptoms are 
headache, nausea, pain in back, legs, and abdomen, 
loss of appetite, coated tongue, epistaxis, diarrhoea. 

Later Symptoms. — The later symptoms are the 
enlarged spleen, Widal's reaction, 1 rash, and liquid 
yellow stools with a "pea soup" appearance. There 
may be either diarrhoea or constipation. 

Temperature. — During the first week, the temper- 
ature rises steadily, being a degree or a degree and a 
half higher each evening, and higher each morning, 
generally reaching 103 or 104 F. by the end of the 
first week. During the second week, the fever re- 
mains continuously high with but slight morning 
remissions. In the third week, these remissions be- 

1 Widal's reaction was discovered by Widal in 1 890. A drop 
of blood serum taken from a suspected typhoid patient is 
mixed with one drop of a culture of typhoid bacilli. As a 
rule, if the patient has typhoid the bacilli in the media will 
within a few minutes lose their motility and collect in clumps. 



A. Synopsis of Important Diseases 39 l 

come more marked, and, in favourable cases, there is 
a gradual decline of the fever, the temperature in mild 
cases even reaching normal by the end of the week. 
In the majority of cases, it does not, however, do this 
until the fourth week, and in some cases not even then. 
It is always a serious symptom when the temperature 
and other symptoms do not abate by the end of the 
tourth week. In such cases, convalescence may be 
deferred till the fifth or sixth week and complications 
are likely to occur. A sudden drop of temperature 
at any time during the disease, unless the pulse rate 
decreases in proportion, is to be regarded with sus- 
picion, as it is a symptom both of haemorrhage and 
perforation. 

The Pulse. — During the first week, the pulse varies 
in rate from about ioo to no. It is full in volume, of 
low tension, and very often dicrotic. In and after the 
second week, it is more rapid— -110-115 — but not 
generally dicrotic. As the temperature falls, the pulse 
should become slower and stronger. The pulse be- 
coming suddenly rapid may indicate either haemor- 
rhage, perforation, cardiac failure or dilatation. 

The Tongue. — The tongue is at first coated and 
white. Later it becomes almost black in the centre 
and very dry. When the tongue begins to clear at 
the edges and to grow moist, the approach of con- 
valescence is indicated. 

The Rash. — The rash, as a rule, appears first on 
the abdomen. It consists of small, scattered, rose- 
coloured spots, that disappear temporarily on pres- 
sure. It develops from the seventh to the tenth day, 
persists for two or three days, and then fades, leaving 
a brownish stain for a time. Successive crops con- 
tinue to appear and fade, till about the middle of the 



39 2 Practical Nursing 

third week. The spots are more abundant on the 
abdomen, the lower part of the chest, and the back, 
and sometimes are not present elsewhere. 

Sudamina. — Sudamina may be present in some 
cases of typhoid. It has the appearance of small 
vesicles. 

Mental Condition. — Typhoid patients are dull 
and stupid. They are apt to be delirious, though not 
violently so. They must at all times be carefully 
watched, as they invariably want to get out of bed. 
A continued low, muttering delirium with picking at 
the bed-clothes is always a bad symptom. 

The Abdomen. — The abdomen may or may not be 
tender. It is sometimes much distended, owing to 
the presence of gas caused by fermentation, which 
may produce paralysis or partial paralysis of the 
intestine. 

The Spleen — The spleen becomes enlarged in the 
very beginning of the disease. It can often be felt 
below the lower border of the ribs by the end of the 
first week. 

Subsultus. — Subsultus or trembling is often pres- 
ent in severe cases. It is considered an untoward 
symptom. 

Complications. — The two greatest dangers con- 
nected with typhoid are haemorrhage and perforation, 
due to the ulceration of the intestine. Either of 
these complications may occur from the beginning 
of the third week. 1 Sudden pain, fall of temperature, 
and quickened pulse are the symptoms of both. In 
perforation — which is the more serious of the two — ■ 
the pain is generally continuous and very severe, 

1 There is sometimes, but rarely, a haemorrhage during the 
first or second week, due to congestion. 



A Synopsis of Important Diseases 393 

though sometimes there is no pain and the condition 
may only be discovered, after death, by autopsy. The 
cause of perforation is that the intestine has ulcerated 
to such an extent that it breaks, emptying its con- 
tents into the abdominal cavity, and, unless an opera- 
tion can be done immediately, the patient may die 
of septic peritonitis in a few hours. 

Nursing: Quiet. — Quiet is of the utmost impor- 
tance in the nursing of typhoid fever. The patient 
must be kept absolutely at rest, in the recumbent po- 
sition, only one pillow, preferably hair, being allowed. 
He must not be permitted to sit up or turn in bed, as 
any undue exertion puts an extra tax upon the heart 
and increases the danger of haemorrhage. When 
turned on his side a pillow must always support the 
back. 

Fresh Air. — The air of the room should be at all 
times fresh. A constant suppl) of "free, flowing air" 
must be provided, the patient being screened from 
draughts. 

Application of Cold. — Headache, insomnia, rest- 
lessness, and irritability may be overcome by the 
use of cold compress, ice poultice, or ice-cap on the 
head, or by simple, cool sponging of the body, being 
careful always not to exhaust the strength by too 
much turning. 

Delirium. — A patient suffering from typhoid fever 
should never be left alone. Attempts to get out of 
bed may bring on haemorrhage; or, in a sudden attack 
of active delirium, the patient may jump from a win- 
dow and a life be lost through carelessness. 

Care of the Mouth. — The mouth and tongue re- 
quire unremitting attention, and must be washed 
thoroughly before and after each feeding. Antiseptic 



394 Practical Nursing 

solutions and lubricating mouth washes give relief, 
but the greatest care must be exercised not to irritate 
the tissues nor cause abrasions of the mucous mem- 
brane. The lips are to be kept from becoming dry 
and cracked by the use of some emollient. A mix- 
ture of epithelium, decomposed foods, and micro- 
organisms must never be allowed to accumulate on 
the teeth or tongue. Even twelve hours' neglect in 
this matter will bring about a lamentable condition. 
Failure to remove it may result in increased tym- 
panites, infection of the salivary glands, infection 
sometimes extending to the middle ear through the 
Eustachian tube, ulceration of the mouth and tongue, 
and even re-infection of the patient. 

Cleanliness. — The hands of the patient must be 
frequently washed with hot water, soap, and nail brush 
and kept free from faeces, a prolific source of re-infec- 
tion. The nails must be kept short and clean. The 
morning and evening cleansing bath is usually per- 
mitted, even when baths for the reduction of temper- 
ature are contra-indicated. The bed and body 
clothing must be kept fresh and free from odour. 
Where involuntary movements of the bowels are fre- 
quent, the mattress should, if possible, be changed. Two 
rubber sheets can be alternated, one being disinfected 
and aired while the other is in use. Oakum pads or 
two or three thicknesses of Japanese paper napkins, 
which can be burned, may be used to receive the dis- 
charges, and thus save much extra washing of linen. 
The bed-clothing must be scant — a single sheet suffices 
for covering when the body temperature is high — ■ 
and in many instances the patient is more comfort- 
able if the night- shirt is omitted during the acute 
stages of the disease. 



A Synopsis of Important Diseases 395 

The Bowels. — Either diarrhoea or constipation is 
usually present. When the former is excessive (more 
than four or five movements a day), the treatment is 
directed toward checking the excess. The patient 
should be bathed locally with an antiseptic after each 
movement of the bowels. When constipation is pres- 
ent, medication likely to cause peristaltic action is 
generally avoided, but it is essential that the intes- 
tines be kept as free as possible of faeces, which are 
filled with bacteria and their toxic products. A soap- 
suds enema is usually given each morning, but never 
except by the physician's order. The greatest caution 
must be observed both in the insertion of the tube and 
in regulating the flow of the water, which should run 
very slowly. If possible, the lower bowel should be 
emptied, thus preventing impaction of the rectum 
and sigmoid flexure and possible re-infection of the 
patient. 

Bladder. — Evacuation of urine must be carefully 
noted and the amount measured. The danger of 
over-distention and consequent inability to void urine 
is common in this disease. The condition occurs most 
frequently in cases where the urine and faeces are 
passed involuntarily. Frequent percussion of the 
bladder should be made to ascertain whether it be full 
or empty. Sometimes catheterisation is ordered, as 
the bladder must be kept free of urine. 

Tympanites. — The rectal tube is often used for 
relief of gas in the intestine. Sometimes it is allowed 
to remain for several hours, and should be watched 
and kept in place. Turpentine stupes and turpentine 
enemata, too, are employed for this purpose by some 
physicians. .They must be applied with the utmost 
care and attention that the patient be not burned. 



39 6 Practical Nursing 

Bed-Sores. — Owing to the protracted course and 
toxic nature of typhoid fever, there is liable to be ex- 
treme emaciation and general debility of the system. 
For this reason, and also because the patient usually 
lies upon his back in order to avoid any pressure upon 
the abdomen, the danger of bed-sores is more immi- 
nent than in any other acute disease. Their formation 
will only be prevented by constant and careful bathing 
with soap and hot water, hardening of the skin by the 
use of alcohol, prevention of chafing by dusting the 
surface with powder, relief from pressure by the use 
of pillows and rings and frequent turning of the body, 
and improvement of the circulation by local massage 
in the parts likely to be affected. 

The Pulse. — The condition of the pulse must be 
constantly watched. When it becomes suddenly 
rapid or feeble, be on the look-out for haemorrhage 
and report at once to the physician. A rapid, full 
pulse, showing over- stimulation, should also receive 
immediate attention. 

Temperature. — The temperature is often reduced 
by the use of the Brandt method, the slush bath, or 
alcohol sponging, all of which are fully described in the 
chapter on baths. When the bath is indicated, its effect 
upon the nervous system and upon the alimentary 
tract is often magical. The patient becomes quiet, the 
tongue clears up, and digestion improves. One or 
another form of bath is usually ordered when the body 
temperature is above 102. 5 ° F. This does not take 
the place of a thorough cleansing bath of warm water 
and soap, which should be given at least once a week. 

Diet. — There is at present considerable diversity in 
the dietetic treatment of typhoid. Some physicians 
allow a variety of easily digested solid food during 



A Synopsis of Important Diseases 397 

the entire course of the disease. Others keep the 
patient on liquids 1 until the temperature reaches nor- 
mal, when a progressive diet is started — that is, a little 
more solid or semi-solid food is added each day to the 
bill of fare, as follows: 

First day. One soft-boiled egg is given in the mid- 
dle of the day. 

Second day. Either an egg or a piece of milk or 
cream toast is given at 4 p.m., in addition to the egg 
given at dinner. 

Third day. A raw-beef sandwich may be added, 
the bread being cut very thin and the crusts removed. 
Thus, gradually, light, easily digested food, such as 
oysters, rice, farinaceous puddings, custard, jellies, 
chicken, chops, steaks, and white fish may be given; 
but all rich foods, those difficult to digest, and any- 
thing of a crusty nature must be avoided for some 
weeks. 

Disinfection. — The minutest attention must be 
given to detailed precautions, re-infection of the pa- 
tient, infection of others, or infection of the nurse her- 
self. After handling clothing or utensils, bathing, or 
in any way touching the patient, the hands of the 
nurse must at once be disinfected before anything else 
is touched. A basin or plunge of bichloride solution 
1:1000 should always be in readiness, and no haste or 
confusion should prevent its use. The hands should, 
in addition, be well scrubbed with hot water and soap, 
using a brush. The doors, knob, bedstead, chart 
board, and floor about the bed should be kept free from 
germs. All articles used must be either boiled or disin- 
fected. Formaldehyde 2^ is valuable for use in pri- 
vate homes, as it is both effective and odourless. A 
1 Junket is generally included in liquid diet. 



39 8 Practical Nursing 

large pail (if possible tin or agate) partially rilled with 
water can be kept just outside the infected room, and 
all clothing immersed in this will be perfectly safe till 
taken to the range and boiled either in the same pail 
or in a wash boiler kept for that purpose. When the 
bed-clothes are being removed, a rubber or cotton 
sheet should be placed on a chair or on the floor. The 
soiled clothes are enveloped in this and carefully car- 
ried at arms' length from the room. The practice of 
gathering soiled clothing in the arms, thus bringing 
it in contact with the uniform or scattering poisonous 
germs that may dry and thus be disseminated through 
the air to be afterwards inhaled or swallowed by the 
unwary, is unhygienic in the extreme. The proper dis- 
posal of excreta in this disease is of the utmost im- 
portance, as the germ is known to reside in both urine 
and fasces. A small amount of disinfectant should 
always be kept in the bed-pan, which should be 
covered, on being removed from the patient. When it 
is necessary to retain faeces for inspection, a thick cloth 
or old bath towel well saturated with disinfectant 
should be drawn tightly over the pan. The faeces must 
be well broken up and saturated with equal parts of a 
disinfectant before it is thrown into the sewer pipes. 
In caring for a case of typhoid in the country, the ex- 
creta should be mixed with sawdust and burned. If 
this be impossible, a trench may be dug, not less than 
three feet deep, and at a safe distance from the water 
supply, into which the excreta can be thrown and then 
covered with a quantity of chloride of lime or plain 
slacked lime sufficient to insure the rapid destruction 
of the germs. Earth closets or vaults should never 
be used, as there is danger of contamination of 
the water supply. When the disease terminates, 



A Synopsis of Important Diseases 399 

fumigation of the room, blankets, and articles used is 
a wise measure. 

Typhus Fever 

Typhus fever is one of the most highly infectious 
diseases. It is both endemic and epidemic. It is 
essentially a filth disease, and occurs chiefly in dirty, 
overcrowded tenement districts. In former years, 
outbreaks of the disease were common in jails and 
camps, and it often followed times of famine. 

Incubation. — The period of incubation is about 
twelve days. 

Symptoms. — The symptoms are chill, rapid rise of 
temperature, accompanied by the usual febrile symp- 
toms, intense headache, delirium, and a typical rash 
which appears on the fourth day. This rash comes out 
gradually and is very diffuse, especially upon the 
chest, abdomen, arms, and thighs. It consists at first 
of slightly elevated, irregular, rose-coloured macules, 
which soon grow dusky in hue,. lose their elevation, and 
become petechial. 

Temperature. — The temperature remains continu- 
ously high during the first week. In the second 
week, its morning remissions are more marked, and 
on the thirteenth or fourteenth day it falls to normal. 
Convalescence is prompt. 

Prognosis. — In severe cases the patient may die in 
three or four days, before the appearance of the rash. 

Nursing. — The nursing is the same as in all febrile 
infectious diseases. An abundant, continuous supply 
of pure, fresh air is of the utmost importance. 

Whooping-Cough (Pertussis) 

The specific cause of infection has not yet been dis- 
covered, but it is probably given off in the breath and 



4-oo Practical Nursing 

sputum. It enters the body through the respiratory 
tract. The disease is characterised by an acute 
catarrh of the mucous membrane of the respiratory 
organs. 

Incubation. The period of incubation varies from 
four to fourteen days. 

Symptoms. — In the first stage, which lasts from one 
to two weeks, the symptoms are those of an acute 
bronchitis with slight fever (ioi° to 102 F.). In the 
second stage, the fever subsides, the cough becomes 
more frequent and is often accompanied by paroxysms 
of breathlessness, caused by a spasmodic closure of the 
glottis, which gives rise to the characteristic whoop. 
In mild cases, there may be only two or three par- 
oxysms a day, while in others there are as many as 
fifty to eighty. 

Complications. — The possible complications are 
ecchymosis of the eye, nose, and throat; severe vomit- 
ing and diarrhoea; broncho-pneumonia and convul- 
sions. Collapse of the lungs sometimes occurs in 
infants. 

Nursing. — Isolate the whooping-cough patient 
from children. Disinfect his sputum. See that he 
is warmly but loosely clad. Keep him as much as 
possible in the open air. At all times provide a 
constant current of fresh air, but guard against 
draughts. 

Severe paroxysms can sometimes be checked by 
inducing vomiting. 

Yellow Fever 

Yellow fever is a disease peculiar to tropical and 
semi-tropical countries. It is transmitted by means 
of a specific mosquito — Stegomyia fasciata. 



A Synopsis of Important Diseases 401 

Incubation. — The period of incubation varies from 
a few hours to five days. 

Symptoms. — The invasion is acute, beginning, as a 
rule, with a chill, or, in children, with convulsions. 
The temperature rises, during the chill, to io3°-io4° F. 
There is muscular pain, especially in the legs and 
lumbar region, jaundice of the skin and conjunctivae. 
The eyes look watery, glazed, and sunken. Albumi- 
nuria appears early in the disease, but usually clears 
up as soon as the other symptoms subside. There 
may be haemorrhage from any part of the body. The 
"black vomitus" signifies haemorrhage into the 
stomach. 

Temperature. — The temperature, except during 
and after the chill, is rarely very high even in extreme 
cases. As a rule, it falls shortly after the chill to 102 
or 103 ° F., and remains so until the second, third, or 
fourth day, when it falls to about normal. It remains 
thus for twenty- four to thirty- six hours, and then rises 
to 102 or a little above. If recovery takes place, it 
subsides either by crisis or lysis — in a day or two. 

The Pulse. — During the initial fever, the pulse 
varies from 90 to 115, but during the secondary 
fever, unless haemorrhage takes place, it is generally 
comparatively slower. It may be exceedingly feeble. 

Suppression of urine and haemorrhage are the two 
most dreaded features of the disease. 

Nursing. — The specific points to be remembered 
are: the necessity of keeping the patient quiet, to les- 
sen the danger of haemorrhage; doing everything pos- 
sible to relieve the muscular pain, which is at times 
intense 1 ; and watching the quantity and quality of 

!Hot applications, counter-irritants, and massage are the 
treatments most frequently ordered for this purpose. 
26 



4-02 Practical Nursing 

the urine. The patient should be kept screened from 
mosquitoes to avoid the spreading of the disease. 

Convalescence is comparatively rapid in yellow 
fever, but there may be some irritation of the stom- 
ach, feebleness of the heart action, and lack of general 
tone for some weeks. 

Diseases Due to Animal Parasites 

Cestodes (Tapeworms). — There are several varie- 
ties of cestodes, some of which infest the intestines 
and others the viscera. The former are the most 
common. The most frequent method of inoculation 
is by eating infected meat. Their presence is indi- 
cated by the segments of ova of the worms in the stool, 
and by diarrhoea, colic, fever, anaemia, and nervous- 
ness. When the worm is expelled, it is always im- 
portant to notice if the head is there, as the worm 
will grow again if the head remains in the intestine. 

Nematodes. — The eggs of the nematodes are in- 
gested with water or uncooked food. There are sev- 
eral varieties : 

i. Ascaris lumbricoides, the " round worm." It 
looks like an earthworm. The males are five to six, 
and the females eight to ten inches long. 

2. Oxyuris vermicularis, the thread or seat worm, 
a fine white worm, one-fifth to two-fifths of an inch 
long. When ingested, it multiplies with great rapidity 
in the rectum and ccecum. It produces pruritis ani, 
restlessness and nervousness, and in children is fre- 
quently the cause of convulsions. When any of these 
symptoms are present without discoverable cause, the 
dejections should be carefully inspected. Anthelmintic 
enemata are generally ordered. The liquid must be 
injected as high as possible, since to be of use it should 



A Synopsis of Important Diseases 4°3 

reach the ccecum. When there is any irritation 
around the rectum, the affected surface should be 
washed with warm water and soap, well dried, and 
powdered at least three or four times a day. 

3. Ankylostoma duodenale, a small worm that 
attacks the intestine, producing uncinariasis. It is 
common in Southern countries. It may cause 
anorexia, diarrhoea, and severe progressive anaemia. 

4. Filaria, which causes filariasis. These worms 
develop in the lymphatics of the trunk and limbs. 
The embryos, called Filaria noctuma, are discharged 
into the lymph, and at night they enter the peripheral 
blood-vessels. During the daytime they remain in 
the deeper organs. 

5. Trichina, which is derived from eating imper- 
fectly cooked infected food, and which causes trichi- 
niasis (trichinosis). The embryos enter the intestinal 
lymph spaces, and thus reach the voluntary muscles 
where they lodge and develop within the 
sarcolemma. 

Arachnids — Scabies (Itch). — Scabies is due to a 
small parasite just visible to the naked eye. The im- 
pregnated female burrows in the soft skin between the 
fingers, the folds of the elbow, etc., and deposits eggs. 
The larvae also burrow in a fine line about one-eighth 
of an inch long. Papules, vesicles, and pustules form 
around the points of entrance, and there is an intense 
itching, especially at night. The disease is highly 
contagious. Can be carried in bed or body clothing. 

(For malaria see page 259. Yellow fever, page 400. 
Amoebic dysentery, page 253.) 

Insects — Pediculosis Capitis (Head Louse). — 
The pediculosis infests the head and deposits ova 
(nits) on the hair. The lymph nodes may be enlarged 



404 Practical Nursing 

and tender. Eczema of the scalp, extending over the 
neck and behind the ears, is generally present. 

Treatment. — To treat a person infected with head 
lice, saturate the scalp and hair with equal parts del- 
phinium and ether, put on a handkerchief bandage 
of the head, and leave for several hours. Then comb 
the hair with a fine comb. If the nits are not dis- 
solved, wash the hair with hot vinegar. Repeat the 
treatment as often as necessary (see Chapter VI.). 

Pediculosis Corporis. — The pediculosis corporis 
lives on the clothing and infests the hairless parts of 
the body, especially where the clothes press at the 
waist and shoulders (see Chapter VI.). 

Pediculosis Pubis (Crab Louse). — The pediculosis 
pubis infests the pubis and the other hairy parts of 
the body with the exception of the scalp. 

Part II 

NON-INFECTIOUS DISEASES 

Constitutional Diseases. Diseases of the Brain, Spinal 
Cord, and Nerves. Of the Respiratory Organs. Of the Heart, 
Arteries, and Veins. Of the Blood and Ductless Gland. Of 
the Digestive Organs. Of the Urinary System. Of the 
Uterus and Appendages. Of the Muscles. Of the Bones. 
Of the Ear. Of the Eye. 

Constitutional Diseases 

Constitutional diseases are diseases which affect 
the entire system. The principal constitutional 
diseases are the following: 

Beri-Beri. — Beri-Beri is a disease of malnutrition 
due to an excessive farinaceous diet. It is found 
chiefly in oriental, tropical, and sub-tropical countries. 
There are several types, the most common being (i)the 



A Synopsis of Important Diseases 405 

rudimentary, which is characterised by paralysis of 
the muscles, and (2) the atrophic, in which atrophy of 
the muscles takes place. 

Diet. — A lack of proteid diet being the principal 
predisposing cause of the disease, an ample proteid 
diet is of primary importance in the treatment. 

Diabetes Mellitus — Etiology. — Diabetes melli- 
tus is a disease affecting all the organs of nutrition. 
It is characterised by the accumulation of glucose, or 
grape sugar, in the blood, and the excretion of it in 
the urine, which is voided in varying, but usually ex- 
cessive, quantities (six to forty pints a day). 

Symptoms. — The symptoms, in addition to the ex- 
cessive micturition, are intense thirst, a continual 
craving for food, especially sweets, coated tongue, 
dry tongue, bad breath, intestinal disorders (constipa- 
tion is more common than diarrhoea) , rapid emaciation, 
and loss of strength. Eczema of vulva is very com- 
mon in women and is sometimes one of the first symp- 
toms. The urine is of a high specific gravity — 1030 
to 1050 and even higher. 

Causation. — The principal causes of diabetes mel- 
litus are heredity, sedentary habits, over-indulgence 
in drinking and eating, exposure to cold, wet, and 
fatigue, and injuries to the head or nervous system. 

Complications. — The possible complications are 
albuminuria, diabetic coma, eczema, gangrene, pneu- 
monia, and tuberculosis. 

Prognosis. — Many victims die within two or three 
years, but old people sometimes live ten to twenty 
years with no other symptoms than the presence of 
sugar in the urine. 

Nursing. — The diet is one of the most important 
points in the care of diabetic patients. Sugars and 



406 Practical Nursing 

starches must be avoided (see Chapter XXIV.). Fresh 
air is imperative, but all draughts and sudden changes 
of air are to be guarded against. A moderate amount 
of daily exercise is advised when the patient is able to 
take it. 

Diabetes Insipidus. — Diabetes insipidus is a dis- 
ease of nervous origin, characterised by the secretion 
of an abnormally large amount of urine of low specific 
gravity, but which does not contain sugar. 

The severity of the disease depends upon the prim- 
ary trouble. When it complicates any organic disease, 
the general health may be much impaired, but in idio- 
pathic cases it may persist for an indefinite period, 
even for years, and the patient be in comparatively 
good health. 

There is little special treatment, cleanliness, fresh 
air, nourishing food, freedom from undue excitement 
and over- work being the chief points. 

Gout. — Gout is more common in middle life and in 
men. The predisposing causes are heredity, over- 
indulgence in food and alcoholic drinks, chronic lead 
poisoning, and lack of exercise. It is characterised 
by an excess of sodium urates in the blood, due to the 
over-production or defective elimination of uric acid. 
Crystalline chalk-like deposits form in the cartilages 
of the affected joints, which sometimes necrose. In 
acute gout, there is pain and swelling, the big toe being 
generally the joint first affected. The condition is at- 
tended with symptoms of indigestion, varying fever, 
ioi°-io3° F., and anuria. 

Rheumatism- — Chronic Rheumatism. — Chronic 
rheumatism may come on gradually, or it may follow 
an attack of rheumatic fever. It is characterised by 
changes in the joints, due to thickening and contrac- 



A Synopsis of Important Diseases 4°7 

tion of the fibres, which frequently result in deformity 
and loss of motion. 

Temperature. — Slight febrile attacks may occur 
from time to time, but there is no constant high 
temperature. 

Nursing. — Hot-air baths, local douching, and mas- 
sage are the general local treatments. Protection 
against cold, wet, and sudden changes of temperature, 
and seeing that the patient has proper food and warm 
clothing are the most important points in the nursing. 

Diet — Plainly cooked white meats — never fried — 
fresh vegetables, fruits, cereals, and tea and coffee in 
small quantities are permissible. Avoid all foods not 
easily digested and those likely to tend to generate 
acid, such as red meat, pastry, rich or highly seasoned 
food of any kind, sweets, and fermented liquors. 
Starchy foods should be limited and all sweetening 
should be done with saccharine. 

Muscular Rheumatism (Myalgia). — In muscular 
rheumatism, the irritation is localised in various 
muscles and there is little constitutional disturbance. 

According to the group of muscles affected, the 
disease is known as: torticollis (muscles of the neck), 
pleurodynia (the intercostal muscles), lumbago (mus- 
cles of the back, especially those in the lumbar region), 
cephalodynia (muscles of the scalp) . 

Treatment. — The treatment generally consists in 
the application of heat, counter-irritants, and massage. 

Acute Rheumatic Fever. — For acute rheumatic 
fever see "Infectious Diseases." 

Rickets (Rachitis). — Rickets is a disease of mal- 
nutrition supposed to be due to lack of fat, proteid 
food, and salts. It occurs generally in bottle-fed 
babies and in children of the tenements. There is a 



408 Practical Nursing 

lack of lime salts in the bones, which are consequently 
flexible and often misshapen. Such children are late 
in learning to walk and talk and are particularly sus- 
ceptible to disease and attacks of convulsions. 

Nursing. — As in all diseases of malnutrition, fresh 
air, cleanliness and wholesome, easily digested food 
are of primary importance. In rickets, food rich in 
mineral matter, such as fruit juices, and, if the child 
is old enough, vegetables and rare or uncooked beef 
should be given. Massage is often ordered, as massage 
and proper manipulation of the extremities will do 
much toward correcting any tendency to deformity 
due to the lack of firmness of the bones. Children 
with rickets should be kept off their feet and trained 
to sit and lie straight. 

Diseases of the Brain, Spinal Cord, and Nerves 

Abscess of the Brain. — The most frequent causes 
of abscess of the brain are : inflammation of the middle 
ear, mastoiditis, caries of the bones of the nose or 
skull, infected wounds of the skull, and certain infec- 
tious diseases — such as influenza, sepsis, erysipelas, 
and infected emboli. 

Symptoms. — Acute cases are generally accompa- 
nied with high fever, but chronic cases develop slowly, 
and in them the fever may be slight or absent. The 
cerebral symptoms resemble those of meningitis. 

Apoplexy — (Cerebral Hemorrhage), (Throm- 
bosis), or (Embolism). — The predisposing cause of 
apoplexy is arteriosclerosis . The exciting cause may 
be anything which leads to an increased blood pres- 
sure, such as overexertion, excitement, overeating, 
and overstimulation. 



A Synopsis of Important Diseases 4°9 

Symptoms. — Sudden vertigo, faintness, and dis- 
turbed speech, followed by coma. The face becomes 
flushed and dusky, or, in very severe cases, ashy pale. 
The breathing is stertorous, slow , irregular, and often 
Cheyne-Stokes. The pulse at first is soft, slow, and 
compressible, but later full, rapid, and bounding. The 
eyes are fixed and staring, the pupils varying, but 
generally unequal. There may or may not be con- 
vulsions, 

The patient may die within a few days or hours; he 
may partially recover and then relapse, or he may 
recover. As he regains consciousness a paralysis will 
be observed, the form depending upon the seat of the 
lesion. 

Treatment. — The patient should be put in the 
recumbent position, his clothing loosened, the head 
of the bed elevated, and ice applied to his head. 

Chorea (St. Vitus's Daxce). — Chorea has been 
variously attributed to cerebral neurosis, a small cere- 
bral embolism, and endocarditis. It is most common 
between the fifth year and puberty and in pregnancy. 
It is characterised by involuntary contractions either 
of single muscles or of groups of muscles, the force 
and frequency of which may be slight or very severe. 
The movements are generally absent during sleep 
and are always increased by attention, emotion, or 
fatigue. 

Nursing. — Nourishing food, fresh air, freedom from 
excitement and fatigue, are the special points for the 
nurse to remember. Severe cases are kept in bed, 
and it is often necessary to bandage the extremities 
to keep them from becoming chafed. Sedatives may 
be needed. Fowler's solution in gradually increasing 
doses is a freauent form c-f treatment. 



410 Practical Nursing 

Eclampsia. — In adult life, toxic poisoning, espe- 
cially uraemia, is the most common cause of an attack 
of general convulsions. In children, convulsions may 
mean much or little, since they may be caused by indi- 
gestion, worms, teething, brain lesions, and the onset 
of disease, especially disease of an infectious character. 

Treatment. — For treatment see Chapter XVI. 

(Edema (Wet Brain). — (Edema may complicate 
obstruction of the veins, nephritis, general oedema, 
tumours of the brain, and abscesses, especially if the 
patient has been addicted to the overuse of alcohol. 

Encephalitis (Inflammation of the Brain). — 
Encephalitis may be either acute or chronic. 

Acute Encephalitis. — Acute encephalitis may follow 
alcoholism, infectious diseases, or trauma. The ma- 
jority of sufferers from this disease die in a short time, 
and there is seldom more than a partial recovery, some 
form of paralysis almost invariably remaining. 

Chronic Encephalitis {Dementia), {Paralytic General 
Paresis). — Chronic encephalitis is nearly always due 
to syphilis. The symptoms are those of increasing 
insanity and inco-ordination of motion, with paraly- 
sis progressing. 

Epilepsy (Falling Sickness). — The most frequent 
predisposing causes of the brain lesion to which these 
attacks are due are heredity, chronic alcoholism, rick- 
ets, infectious diseases, intense fright, heart disease, 
trauma, and pregnancy. 

Symptoms. — There is generally some premonitory 
symptom of the onset of an attack, known as the 
"aura," the nature of which varies in different indi- 
viduals. It is followed shortly by a loud cry and the 
patient becomes unconscious. The spasm is at first 
tonic, but after a few seconds becomes clonic (see 



A Synopsis of Important Diseases 4 11 

Chapter VII.). All the muscles are involved. Owing 
to the excessive movement of the jaws, there is an 
increased secretion of saliva, which flows from the 
mouth. The face is cyanosed, the respiration irregular 
and noisy, and the pupil reflexes are lost. The con- 
vulsion subsides in a few seconds or minutes. The 
patient may then pass into a state of coma, remain- 
ing so for several hours, or he may regain at least 
partial consciousness at once. 

Nursing. — In all cases of convulsions, a nurse 
should take means to prevent the patient from biting 
his tongue by forcing a folded handkerchief or piece 
of wood between the teeth, or otherwise hurting him- 
self. She should also observe carefully the parts of 
the body involved in the convulsion, since this know- 
ledge is an important aid to the physician in localising 
the seat of trouble. 

Herpes Zoster (Shingles). — Herpes is an acute 
inflammation of the spinal ganglia on one side of the 
body. It is accompanied by acute neuralgic pain in 
the intercostal, lumbar, or supra-orbital nerves, and 
a vesicular rash — like a "cold sore" — which is limited 
to the locality of the affected nerve. 

Hydrocephalus. — Hydrocephalus is due to exces- 
sive secretion of cerebro-spinal fluid. In children 
this causes separation of the cranial bones with conse- 
quent enlargement of the skull. The condition may 
be congenital or it may occur in meningeal diseases, in 
cachexia, and in old age. In congenital cases, the 
fontanels fail to close, the head is abnormally large, 
and the forehead bulges, making the face look small. 
Children thus afflicted are never bright. They are 
liable to have frequent attacks of eclampsia, and death 
generally occurs in one to four years. 



4i2 Practical Nursing 

Hysteria. — "A functional neurosis which causes a 
defect in the controlling power of the psychic centres. " 
The predisposing causes are heredity or continued 
over-fatigue either of mind or body, combined with 
an early training which has failed to teach self-control 
and unselfishness. 

Attacks of hysteria take many forms. For instance 
there may be unconsciousness which often lasts many 
hours, or even days; convulsions, phantom tumours, 
spurious pregnancy, catalepsy of an extremity, 1 local- 
ised hypersaethesia or anaesthesia, and real or imagi- 
nary loss of one or another of the special senses. 

Nursing. — Such cases are among the hardest that 
a nurse has to deal with. Tact, kindness, patience, 
firmness, and infinite resource on her part are most 
essential. The patient should be kept quiet, yet 
amused and interested. As a rule, he is not allowed 
to see many, if any, friends. Therefore the task of 
providing him with amusement and diversion devolves 
entirely upon the nurse, and it is a very essential part 
of the treatment, as it is of primary importance to 
keep the patient from thinking of himself and of his 
real or fancied ailments. 

Nurses undertaking the care of nervous patients 
should have some knowledge of massage and hydro- 
therapy, as they are important factors in the treat- 
ment. It must always be remembered that hysteria 
is as much a disease as typhoid, pneumonia, or any 
other radical derangement of the functions. 

In hysterical convulsions the patient usually falls 
so that he is not hurt by the fall. The eyes seem fixed, 
but pressure upon the supra- orbital nerve usually 

i If a leg or arm, for example, is placed in a certain position f 
it will remain so, even for hours. 



A Synopsis of Important Diseases 4 l 3 

brings about reaction. The mention of the applica- 
tion of a cold douche or other severe measure often 
restores consciousness. 

Locomotor Ataxia. — The majority of cases of 
locomotor ataxia follow attacks of syphilis, but 
trauma to the spine or continued arduous work will 
at times bring about the same condition. It is marked 
by a lack of co-ordination and sensation in the extremi- 
ties, especially the legs, which makes walking a 
matter of difficulty 

Meningitis. — For meningitis see " Infectious 
Diseases." 

Myelitis. — Myelitis is a degeneration of the nerve 
fibre in the spinal cord, resulting from inflammation, 
haemorrhage, or injury to any segment of the same. 
It causes a partial or complete paralysis of the legs and 
bladder and loss of sensation in the lower part of the 
body. 

There is great danger of bed-sores. 

Neuralgia. — Neuralgia is a paroxysmal pain along 
the course of the nerves. It may be due to neuritis, 
but there is often no discoverable lesion. The predis- 
posing causes are neurasthenia, a condition of debility 
following disease, overwork, worry, insufficient sleep, 
lead poisoning, diabetes, nephritis, syphilis, and uter- 
ine disease. Attacks are most frequently induced by 
exposure to wet or cold, and local or reflex irritation 
of a nerve. 

Neurasthenia. — The causes of neurasthenia are 
heredity, over-work, worry, excitement, loss of bod- 
ily strength by long illness, and the use in excess of 
stimulants. 

Symptoms. — The principal symptoms are restless- 
ness, insomnia, constant imaginings of pain — which 



414 Practical Nursing 

are very real to the patient, — attacks of vertigo and 
palpitation, fear of disease, or in some cases of crowds 
or open spaces, an increasing inability to fix the atten- 
tion upon or to do mental work, and a tendency to 
hysteria. In many cases there are specific complica- 
tions, such as anorexia, constipation, indigestion, and 
migraine. 

Nursing. — As in all nervous diseases everything 
depends upon the personality of the nurse and on her 
understanding the physicial conditions that control 
the patient. She must be firm, resourceful, kind, and 
very determined. Such cases often require one or 
two years for recovery and are very taxing, as the 
nurse must constantly give the moral support that 
is lacking in the patient. It is of the utmost import- 
ance for the patient to have his attention diverted 
from himself; to avoid all fatigue, both mental and 
bodily; and to do everything to build up the system. 
Hydrotherapy is now much used for the relief of rest- 
lessness and insomnia. 

Neuritis. — Neuritis is inflammation of a nerve or 
nerves. When only one nerve is affected, it is called 
localised neuritis; when many, multiple neuritis or 
polyneuritis. 

Localised Neuritis. — Localised neuritis is gener- 
ally due to either contiguous inflammation, trauma, or 
stretching of a nerve. It is characterised by intense 
pain along the course of the affected nerve and hyper- 
esthesia, followed in severe cases by paresthesia, 
numbness, and later by loss of sensation and paralysis. 
The symptoms may abate in a few days, but some- 
times they continue for weeks. 

Polyneuritis. — May be caused by: prolonged ex- 
posure to cold; poisoning by alcohol, ether, lead, 



A Synopsis of Important Diseases 4*5 

arsenic, or mercury; infectious diseases — especially 
sepsis, — and other diseases such as anaemia and cancer. 
The lesions are the same as in localised neuritis, but 
several nerves in different parts of the body are 
affected, and constitutional symptoms are more pro- 
nounced. The onset is generally abrupt, beginning 
with a chill and followed by high fever and often by 
delirium. The worst cases die in one or two weeks 
from paralysis of the respiratory muscles or of the 
heart. Other cases continue to grow worse, or remain 
stationary for a few weeks and then recover slowly, 
sometimes taking a year or more to convalesce. In 
the longer cases, permanent contractions are frequent. 

Neuroma. — Neuroma is a nodular enlargement of a 
nerve. Some neuromata cause no trouble. Others 
give rise to pain, anaesthesia, paraesthesia, or paraly- 
sis. Such, when accessible, are generally excised. 

Nursing. — Local applications are of small value. 
There is therefore little to be done except to keep the 
patient warm, well nourished, and diverted. 

Paralysis. — Paralysis is a loss of function or volun- 
tary control in a muscle or group of muscles. The 
condition is generally due to some lesion of the brain, 
spinal cord, or peripheral nerves. The muscles affected 
will depend upon the seat of the lesion in the brain or 
cord, or, if the condition is due to injury to or disease 
of a nerve, the muscles affected will depend upon the 
location of that nerve and the nature of its trouble. 

When only one extremity is paralysed the paralysis 
is known as monoplegia. Paraplegia signifies a loss 
of power in either both arms or both legs; and hemi- 
plegia, paralysis of one whole side of the body. When 
there is only a partial loss of power the condition is 
known as paresis. 



4i 6 Practical Nursing 

There are many forms of paralysis. The following 
are among the most common : 

i. Ascending paralysis, which begins in the legs 
and spreads rapidly to the trunk, arms, shoulders, and 
neck, causing death in a short time, from paralysis of 
the respiratory organs. 

2. Bulbar paralysis, due to degeneration of the 
motor cranial nerve nuclei in the medulla. The onset 
and course of the disease are slow. The tongue is 
first affected, then the lips, palate, pharynx, and 
larynx, successively. Death is finally due either to 
marasmus or paralysis of the respiratory centres. 

3. Diphtheritic paralysis, which sometimes follows 
diphtheria. The muscles of deglutition are the mus- 
cles most frequently affected. 

4. General paralysis, due to organic lesion of the 
brain. It is characterised by a gradual loss of power, 
and deterioration of the mind. 

5. Hysterical paralysis, which is associated with 
hysteria. There is no causative lesion. 

6. Infantile paralysis (acute anterior poliomyeli- 
tis) , which occurs most frequently from the second to 
the fourth year. The onset is generally sudden, be- 
ginning either with acute fever or convulsions and a 
sudden loss of functional power in one or more of the 
extremities. The primary symptoms subside in a 
few days, but the paralysis remains, and there is sel- 
dom a complete recovery. 

7. Paralysis agitans (palsy), characterised by a 
constant tremor of the muscles. 

8. Writers' paralysis (occupation neurosis), (writ- 
ers' cramp), which occurs in penmen, pianists, violin- 
ists, seamstresses, etc. It is characterised by pain 
and either lack of control or loss of motion in the 



A Synopsis of Important Diseases 4 T 7 

affected fingers. It occurs most frequently in neu- 
rotic subjects. 

Nursing. — An easily digested, nourishing diet, 
plenty of fresh but not too cold air, and massage are 
the main points in the treatment. The more than 
usual danger of bed-sores due to defective circulation 
must be remembered and guarded against. 

Pott's Disease (Caries of the Spixe). — Pott's 
disease may follow trauma or it may occur spontane- 
ously. It is of a tuberculous nature. The pressure 
upon the cord occasionally causes partial or complete 
paralysis below the affected point. Almost all " hump 
backs " are due to Pott's disease. 

Spina Bifida. — Spina bifida is a tumour present at 
birth of a child, on its vertebral column, usually over 
the sacral vertebrae. It is caused by the protrusion 
of the spinal meninges through an opening in the spinal 
canal. This tumour is filled with cerebro-spinal fluid. 

Tumours. — Both the brain and the spinal cord may 
be the seat of new tumorous growths, malignant or 
otherwise. The resulting pressure will cause loss of 
function in some part of the body, the part depending 
upon the locality of the tumour. 

Diseases of the Respiratory Organs 

The Nose — Adenoids. — Adenoids are an hypertro- 
phy of the adenoid tissue. It is a common disease of 
childhood. If the adenoids are of any considerable size, 
the patient usually keeps his mouth open and thus 
acquires a stupid expression. There is a tendency to 
catch cold and to have catarrh. They should if 
possible be removed during early childhood. The 
Eustachian tube is often obstructed and from this ear 
trouble may result. After puberty, the adenoid tissue 
27 



4i 8 Practical Nursing 

generally shrinks to its normal size, but the ill effects 
are liable to be permanent. 

Hay Fever. — Hay fever is an acute catarrhal con- 
dition with asthmatic breathing due to some irritant, 
usually the pollen of a plant. The predisposing 
causes are a neurotic idiosyncrasy or some nasal ab- 
normality. 

Acute Rhinitis (Coryza), (Cold in the Head). — 
Acute rhinitis is an inflammation of the mucous 
membrane of the nose accompanied by a watery or 
muco-purulent discharge. 

Chronic Rhinitis (Chronic Nasal Catarrh). — 
Chronic rhinitis may follow repeated attacks of acute 
rhinitis, or be the result of disease, severe climatic 
changes, or the inhalation of irritants such as chem- 
icals or dust. 

The Pharynx and Tonsils. — Retropharyngeal 
Abscess. — Retropharyngeal abscess may occur as a 
primary disease, but it more often follows scarlet fever 
or some other infectious diseases. The abscess causes 
an obstruction in the throat, resulting in dysphagia 
and dyspnoea. The chief danger is when the abscess 
ruptures, as the pus may enter the larynx and cause 
asphyxia or pneumonia. 

Follicular Tonsillitis. — Follicular tonsillitis is an 
inflammation of the tonsils, due to the streptococci or 
staphylococci of suppuration or to rheumatism. Pre- 
disposing causes are former attacks, enlargement of 
the tonsils, and exposure to cold or wet. Either one 
or both tonsils may be affected. 

Symptoms. — The tonsils are red and swollen and 
covered, or partly covered, with whitish patches that 
somewhat resemble the false membrane of diphtheria. 
There are pain in the throat, a high temperature (103 



A Synopsis of Important Diseases 4*9 

F.), a general malaise, and marked prostration. As a 
rule, the fever falls by lysis, and the other symptoms 
abate within a week. 

Suppurative Tonsillitis (Quincy Sore Throat). 
— Suppurative tonsillitis generally begins as a follicular 
tonsillitis, but the throat symptoms all rapidly in- 
crease. There is intense pain, and the throat is covered 
with a thick mucus. After a few days, an absqess 
forms, and, unless incised, ruptures, discharging a 
thick, fetid pus. 

Ulcers of the Tonsils. — Syphilis is suspected 
when there are deep ulcers on both tonsils ; carcinoma 
when there is an irregular spreading ulcer accompanied 
by a thin, greenish, fetid discharge. 

Nursing. — Astringent and antiseptic gargles or 
sprays are the main features in the treatment of all 
diseases of the throat. The local inflammation is 
much relieved by the application of ice poultice bound 
firmly over the tonsil. A strong cathartic is usually 
ordered, not only to clear out the intestine, but also 
to act as a counter-irritant and, by exciting a strong 
peristaltic action of the intestine, draw the blood 
away from the point of congestion. As the tonsils are 
directly connected with the cervical lymph glands, 
any disease attacking them is liable to be associated 
with comparatively severe constitutional symptoms 
and a general debility of the system. To counteract 
this condition as much as possible, a liberal wholesome 
diet should be given as soon as the throat symptoms 
abate. 

The Larynx — Acute Catarrhal Laryngitis. — 
Acute catarrhal laryngitis is a catarrhal inflammation 
of the larynx due to cold, over-use of the voice, or local 
irritation, 



4 2 o Practical Nursing 

Symptoms. — There is a tickling sensation in the 
throat and slight pain. The larynx and vocal cords 
are red and slightly swollen. The voice is hoarse and 
in some cases there is aphonia. There may or may 
not be a slight fever. 

Steam inhalations are often prescribed. 

Chronic Catarrhal Laryngitis. The symptoms 
are the same, only less severe, as in acute cases. They 
are more or less constant. 

(Edema of the Larynx. — (Edema of the larynx 
may occur in connection with any severe inflammatory 
condition of the throat, or in nephritis. 

Symptoms. — A puffy soft swelling of the larynx, 
aphonia, and dyspnoea may come on very suddenly, 
resulting, unless preventive measures are immediately 
taken, in asphyxia and death. Intubation or 
tracheotomy is often necessary, and the proper ap- 
paratus should in severe cases always be kept ready 
for instant use. 

Spasmodic Laryngitis (Laryngismus Stridulus), 
(Croup). — Spasmodic laryngitis is a neurotic spasm 
of the adductors of the vocal cords. The symptoms 
are alarming but not dangerous. The child generally 
awakens in the night with a hoarse, croupy cough, 
dyspnoea, and, unless relieved, cyanosis. The attack 
may last for an hour or two, after which the child will 
then go to sleep, awakening in the morning per- 
fectly well or with only a slight laryngitis. The 
attack may be repeated on two or three successive 
nights. 

Treatment.— The treatment consists of steam inhal- 
ation, hot compresses to the throat, and cold com- 
presses to the head. A hot bath 105 ° F. is also 
sometimes given. Inducing vomiting, by means of an 



A Synopsis of Important Diseases 4 21 

emetic or by tickling the back of the throat with the 
finger, will abort a spasm. 

Syphilis of the Larynx. — In syphilis of the 
larynx there will be congestion and ulceration of the 
larynx, resulting in change of voice, pain in swallow- 
ing, and permanent deformities. Severe cases may 
die of asphyxia from oedema of the larynx. This, 
like all other forms of syphilis, is highly infectious, 
and, to prevent infecting herself and others, the 
nurse must disinfect her hands thoroughly after 
touching the patient or anything used by him; also 
the bed-clothes, towels, dishes, and the specific dis- 
charge. The use of paper sputum cups and gauze, 
instead of handkerchiefs, should be insisted on, and 
these should be burned. 

Tubercular Laryngitis. — Tubercular laryngitis 
usually occurs as a complication of pulmonary tuber- 
culosis. In the primary stages there is anaemia of 
the mucous membrane. Later, ulcers develop, the 
cartilages may become necrotic, the vocal cords 
paralysed, and the swelling so intense that trache- 
otomy will be necessary. The danger of infection 
must be remembered and the disinfection usual in 
such cases adhered to. 

The Bronchi — acute bronchitis. — Acute bron- 
chitis is an acute catarrhal affection of the trachea 
and bronchi. It may be caused by the inhalation 
of irritating gases, by exposure to cold and wet, or it 
may complicate or follow other diseases. 

Symptoms. — There are sore throat, a general 
malaise and a constant cough which causes pain in the 
sternal region. The sputum is scanty at first, but 
later is abundant and of a viscid, muco- purulent 
nature. The temperature is generally about ioi° 



422 Practical Nursing 

or io2° F., but may run as high as 103 F. It gen- 
erally falls within a week, though the cough and 
other symptoms may continue for some time longer. 

Chronic Bronchitis. — Chronic bronchitis occurs 
after repeated acute attacks. It is also frequently 
associated with other chronic diseases, and is a fre- 
quent complaint of the aged. The symptoms are 
those of acute bronchitis, but much modified. 

Nursing. — The cough in bronchitis is frequently 
very distressing. Poultices are often ordered to 
relieve it, and hot drinks, especially hot lemonade, 
are very effective and should be tried. Steam in- 
halations are frequently ordered (for methods of 
giving see Chapter XV.). In bronchitis, as in all 
lung diseases, it is exceedingly necessary to have a 
constant supply of fresh air; but the greatest care 
must be taken to guard against draughts and to keep 
the patient warm and well covered. 

Bronchial Asthma. — Bronchial asthma is char- 
acterised by paroxysms of dyspnoea, which are sup- 
posed to be due to spasm of the muscles of the 
bronchi. In addition to the dyspnoea, there will be 
cyanosis, vertigo, sweating, a sense of suffocation, 
and a weak, frequent pulse. 

Treatment. — Nitrate of amyl or inhalations of 
stramonium leaves are often ordered. The patient 
should be given plenty of fresh air. Hot drinks or 
a hot foot-bath will frequently give relief. Change 
of climate is often advised. 

The Lungs — Abscess of the Lung. — Abscess of 
the lung generally occurs as a secondary condition to 
pneumonia or suppurative disorders of the upper 
air-passages. 

Symptoms. — There are a more or less marked 



A Synopsis of Important Diseases 4 2 3 

septic condition, pleurisy, cough, and a foul, fetid 
pus expectoration. 

Congestion of the Lung. — Congestion of the 
lung is characterised by an increased blood supply 
which produces dilatation and congestion of the 
pulmonary vessels. It may be caused by the in- 
halation of irritating substances, by cold, or by 
alcoholism ; or it may occur in patients lying for a 
long time in the same position. It is also a frequent 
symptom in cardiac disease. 

(Edema of the Lungs. — (Edema of the lungs is 
characterised by a transudation of serous fluid from 
the blood-vessels into the stroma and air spaces. 
It frequently occurs in anaemia, severe cases of 
pneumonia and other lung diseases; heart, kidney, 
brain, and infectious diseases. Its advent is recog- 
nised by a stertorous, rattling breathing, increasing 
dyspnoea, and cyanosis. 

Emphysema. — Emphsemya is generally due to a 
diseased condition of the lungs. The air cells become 
distended and the walls between them broken down. 
As a natural consequence, the cells are larger and 
the number of blood-vessels relatively fewer, and this 
means a diminished surface for the aeration of the 
blood. Emphysema may also be the result of 
injury, especially of wounds of the trachea. 

Gangrene of the Lung. — Gangrene or necrosis of 
the lung tissue is due to the action of putrefactive 
bacteria. The predisposing causes are pneumonia, 
diabetes, wounds of the lung, embolus, or aneurism. 

Symptoms. — The symptoms resemble those of 
abscess of the lung, but the sputum is more abundant, 
darker, fetid, and putrid. 

Hydrothorax (Fluid in the Thorax). — Hydro- 



4 2 4 Practical Nursing 

thorax may be due to local causes, such as cancer 
of the lung or pressure upon the vena cava, or it may 
be part of a general anasarca. There are dyspnoea, 
more or less cyanosis, and a constant short cough. 
Aspiration is generally performed to draw off the 
liquid. 

Pleurisy. — Pleurisy is an inflammation of the 
serous membrane which covers the lungs and lines the 
thoracic cavity. It may be either local or general, 
and either dry or with effusion. 

Symptoms. — It may begin with a chill and fever 
(ioi°-io3° F.), or the onset may be gradual. There 
is a short dry cough, severe pain on coughing or 
breathing, and rapid, shallow respiration. There 
is less pain in pleurisy with effusion than with dry 
pleurisy, the fluid acting as a lubricant to the in- 
flamed surfaces. 

Treatment. — The patient should be kept quiet, and 
a tight binder or strapping of adhesive plaster applied 
to restrict the breathing and thus lessen the pain. 

Pneumonia. — For pneumonia, see "Infectious 
Diseases. " 

Pneumothorax. — Pneumothorax is air in the 
pleural cavity. This is generally the result of per- 
foration of the lung, due to tuberculosis, abscess of 
the lung, gangrene, empyaema, a fractured rib, im- 
proper use of the aspirating needle, or sudden extreme 
muscular effort. 

Diseases of the Heart 

Concerning Compensation. — The heart has a 
certain reserve force, by means of which it can, for a 
certain length of time, do more work than it is usually 
called upon to perform, and which, when any part 



A Synopsis of Important Diseases 4 2 5 

of it becomes diseased, often allows of its adjusting 
itself to the new conditions, thus minimising the ill 
effects of the disease. When this happens, the heart 
is said to be compensated, and a patient may have 
heart disease for years without knowing it or being 
incommoded by it, beyond an occasional shortness 
of breath when climbing or walking quickly. If, 
for any reason, the heart ceases to adjust itself to 
the conditions forced upon it by disease, there is 
said to be "a failure of compensation." Failure 
of compensation may be caused by illness, extreme 
exertion, or emotion. Sudden deaths are frequently 
due to failure of compensation. 

Axgixa Pectoris. — Angina pectoris occurs in 
connection with various heart lesions, such as coro- 
nary sclerosis, myocarditis, and aortic insufficiency. 
The most frequent exciting causes are undue exertion 
or emotion, severe climatic changes, and indigestion. 
The condition is characterised by a sudden intense 
pain in the heart (radiating to the left shoulder and 
down the left arm . The pain is frequently the 'only 
symptom, but sometimes there are pallor, cold, 
clammy sweat, and dyspnoea. The pulse is generally 
accelerated, irregular, and of a high tension, and there 
is an intense fear of impending death. As a rule. 
the attack proper lasts only a few seconds or minutes. 
but it may be days before the patient recovers from 
its effects. 

Dilatation. — A certain amount of dilatation is 
frequently one of the means by which the heart ad- 
justs itself to the extra work forced upon it by disease. 
It may cause no adverse symptoms, but, at times, 
there may be headache, dyspnoea, syncope, and 
cardiac pain. These symptoms will all be increased, 



426 Practical Nursing 

if over-dilatation takes place, and death may ensue. 
This may be the result of failure of compensation; 
severe over-exertion, such as mountain climbing; 
or of prostrating disease. 

Endocarditis. — Endocarditis is an inflammation 
of the endocardium, the membrane lining the heart. 
There are three forms, acute, chronic, and malignant. 

Acute Endocarditis. — Acute endocarditis is usually 
secondary to acute rheumatism, scarlatina, pneu- 
monia, or tuberculosis of the lung. It sometimes 
occurs in chronic endocarditis, diabetes, nephritis, 
infectious diseases, and diseases of malnutrition. 
The condition may clear up in a few weeks, but it 
more commonly becomes chronic. 

Chronic Endocarditis. — Chronic endocarditis may 
follow acute endocarditis, or it may be chronic from 
the start. It is frequently associated with inflam- 
mation of other organs of the body. 

Malignant Endocarditis. — Malignant endocarditis 
is usually secondary to some other disease. The 
condition is that of an intensified acute endocarditis. 

Fatty Heart. — Fatty heart is generally caused 
by over-eating and lack of exercise. It is a fatty 
infiltration of the tissue. 

Hypertrophy. — Hypertrophy is a thickening of the 
heart muscle. It is the principal factor in compensa- 
tion. The condition sometimes, however, causes head- 
ache, tinnitus, flushing of the face, cardiac pain, etc. 

Neurosis. — Neurosis is a nervous affection of the 
heart in which there is no real heart lesion. It occurs 
most frequently: (i) in connection with hysteria, 
neurasthenia, gastric distention, and anaemia; (2) in 
organic disease of the heart; (3) as a result of the 
over-use of tobacco, or stimulants. The symptoms 



A Synopsis of Important Diseases 4 2 7 

occur only in paroxysms. They are : a consciousness 
of violent, rapid, and often irregular heart action; 
cardiac pain; dyspnoea; and a sense of suffocation. 

Pericarditis. — Pericarditis is an inflammation of 
the pericardium, the membranous sac which sur- 
rounds the heart. It is usually secondary to other 
diseases. 

Valvular Disease of the Heart. — Valvular 
disease of the heart is both congenital and acquired. 
When the former, it is usually the valves of the right 
side which are affected; when the latter, those of 
the left. Its more common cause is one or another 
of the infectious diseases, particularly rheumatism. 
One or more valves may be affected at a time. Val- 
vular disease is always associated with endocarditis. 

Regurgitation. — Regurgitation is a flowing back 
of the blood, due to the improper closing of the valve. 
This is most commonly the result of endocarditis. 

Stenosis. — Stenosis is a thickening of the valve 
which obstructs the blood current. If the mitral 
valve is affected, it is called mitral stenosis, if the 
aortic, aortic stenosis. 

Nursing. — A most important point in the nursing 
of patients troubled with heart disease is to keep 
them in a comfortable condition. This is at times 
very difficult and requires considerably ingenuity 
as owing to the presence of oedema and dyspnoea, 
such patients are liable to be very restless and in 
great bodily distress. When dyspnoea is present, 
a patient generally requires to be propped up in 
bed, or an easy chair, and supplied with a sufficient 
number of pillows to support him comfortably and to 
provide a rest for his arms. * It is also generally 
necessary to devise some arrangement, such as is 



428 Practical Nursing 

suggested in Chapter VI., to keep him from slipping 
down in bed. Freedom from worry, exertion, and 
excitement is imperative, and all sudden movements 
and startling noises should be avoided. As in every 
disease complicated by dyspnoea, fresh air is of more 
than usual importance, but the air must be warm, since 
owing to a defective circulation, such patients 
generally feel the cold intensely. The diet is also 
of consequence and a difficult matter to regulate. 
As there is always a tendency to flatulence in heart 
disease, foods, such as sugar and starch, which will 
increase this condition, are generally restricted; 
also liquids, when there is oedema. A milk diet is 
most commonly given during exacerbations of any 
cardiac disease, and in order to give all the nourish- 
ment possible in small volume, the milk is often 
fortified with such substances as egg albumen, 
lactose, etc. 

Diseases of the Arteries 

Aneurism. — Aneurism is the dilatation of an 
artery due to the weakening or rupture of one or 
more of its coats. Aneurisms are named, according 
to their shape, fusiform, sacculated, or dissecting. 
In the last-named form, the coats of the artery are 
torn and the blood current forces its way between 
them. The thoracic aorta is the most common seat 
of aneurisms. Fatal haemorrhage, either internal or 
external, may occur from rupture of the aneurism. 

Arterio-sclerosis. — Arterio-sclerosis is an indura- 
tion, or hardening, of the walls of the arteries. It 
comes on naturally *in all old people; but certain 
things, such as heredity, disease, the over-use of 



A Synopsis of Important Diseases 429 

alcoholic stimulants, etc., sometimes lead to its early 
development, or to its development to an unusual 
degree. When the latter is the case, renal or cerebral 
complications are liable to occur. 

Disease of the Veins 

Phlebitis. — Phlebitis is inflammation of a vein. 
It is nearly always associated with thrombosis. It 
most frequently occurs as a complication of typhoid 
or other infectious disease, or of varicose veins, the 
femoral vein being the one most frequently affected. 

Nursing. — The extremity is generally elevated 
and ice-caps applied. It must be kept quiet and 
never rubbed, as rubbing might dislodge the thrombus 
and allow it to be carried to the heart or brain, which 
would prove fatal. 

When a thrombus moves from its primary positions, 
it is called an embolus. 

Diseases of the Blood, Ductless Glands, and Spleen 

Addison's Disease. — Addison's disease is caused 
by tubercular or other disease of the adrenals, or 
suprarenal capsules, and by disease of the abdominal 
sympathetic ganglia. It frequently follows tuber- 
culosis in other parts of the body. 

Symptoms. — The principal symptoms are: a bronze- 
coloured skin, pigmentation of the mucous membranes, 
attacks of dyspnoea, headache, syncope, weak, rapid 
pulse, lack of mental vigour, apathy, slowness of 
speech, lack of appetite, and indigestion. 

Anemia. — In anaemia there are certain differences 
in the proportion of the red blood cells to the amount 
of haemoglobin and in the number of the leucocytes. 
Anaemia may be primary or secondary. For the 



43° Practical Nursing 

former, no adequate cause has been discovered. 
There are several varieties; they are generally 
due to changes in the blood-forming organs. 
The latter follows haemorrhage, starvation, diseases 
which interfere with the organs of digestion or in 
which there is excessive albuminous w r aste, and any 
chronic wasting disease. In it, the number of red 
blood cells and haemoglobin are reduced and the 
red blood cells are small and pale. 

The symptoms are pallor of the skin and mucous 
membrane, dyspnoea on exertion, indigestion, loss 
of appetite and strength. Fainting and neuralgia 
are common, also oedema of the ankles, at night, 
and puffiness of the eyelids. 

Pernicious Anemia. — The symptoms are those 
of a severe anaemia. There is a characteristic lemon- 
yellow skin, the blood coagulates slowly, and there is 
a tendency to haemorrhage into the skin and mucous 
membrane. In severe cases, pus may form around 
the edges of the teeth. 

Chlorosis. — Chlorosis is a form of anaemia common 
to young girls, especially those who are improperly 
fed, over- worked, or subjected to great mental strain. 
The symptoms are dependent on the extent of blood 
change. There may be malaise, dyspnoea, constipa- 
tion, cessation of menstruation, and a characteristic 
greenish-yellow complexion which gives the disease 
its name. 

Nursing. — The diet is a very important factor in 
the treatment of anaemia. Food rich in salts, such 
as rare beef, vegetables, sweet fruits, etc., should be 
given in abundance. Fresh air in all such cases is 
of more than usual importance, since, owing to the 
destruction of the haemoglobin, the oxygen carrier 



A Synopsis of Important Diseases 43 T 

of the blood, the blood is deficient in oxygen. The 
air must be warm, however, as anaemic patients feel 
the cold intensely. 

Leukemia. — Leukaemia is a disease of the blood 
marked by a large increase of the white blood cor- 
puscles. There are three forms of leukaemia: (i) 
lymphatic, in which the lymphatic glands are en- 
larged; (2) myelogenic, which involves the bone 
marrow; (3) splenic, associated with enlargement of 
the spleen. The spleen may also be enlarged in 
either of the other varieties. 

Pseudoleukemia (Hodgkix's Disease.) — In pseu- 
doleukaemia the lymph-nodes are enlarged, there is 
moderate anaemia, the skin is sometimes jaundiced 
or bronzed, and oedema is common. The course of 
the disease is slow, often lasting two or three years 
or even more. Death, unless caused by inter-current 
disease, is generally the result of exhaustion or of 
pressure by the enlarged nodes on one of the vital 
centres. 

Purpura. — Purpura is a bleeding into the skin, 
mucous membrane, serous cavities, or viscera. The 
exact cause is as yet unknown. There are changes 
in the blood which cause its coagulation to be re- 
tarded and, in some cases, there is a diseased con- 
dition of the walls of the blood-vessels. Purpura 
may follow infectious diseases, diseases of malnutri- 
tion, tuberculosis, cancer, anaemia, leukaemia, rheu- 
matism, and scurvy. It is common in the aged and 
in nervous conditions. When the spots under the 
skin are small, they are called ''petechia"; when in 
streaks, "vibices"; and when in blotches, "ecchy- 
mosis." There are several forms of this disease. 

Arthritic Purpura. — Arthritic purpura is ac- 



43 2 Practical Nursing 

companied by various constitutional symptoms, such 
as sore throat, fever, arthritis, and oedema. The 
purpura appears chiefly around the joints and on 
the legs. Patients usually recover in a week or two. 

Purpura Hemorrhagica. — Purpura hemorrha- 
gica is most common in delicate girls. There may be 
extensive bleeding into the mucous membranes of 
the alimentary canal, into the lungs, kidneys, and 
central nervous system. There is marked anaemia 
and prostration. The fever is moderate. Slight 
cases generally recover in a few weeks, but the prog- 
nosis is bad in severe cases. 

Hemophilia. — Haemophilia is strongly hereditary. 
It is transmitted through the women, who, as a rule, 
are not themselves bleeders, to their male children. 
Such children may bleed to death from the slightest 
scratch. After puberty, the tendency to bleed is 
somewhat lessened. 

Scurvy. — Scurvy has been variously classed as a 
disease of the blood, of malnutrition, and of infection. 
The chief predisposing factors are lack of fresh air 
and vegetable food; excessive use of salt meats. 
Infantile scurvy occurs chiefly in children who have 
been fed on sterilised or condensed milk or proprietary 
foods. The principal symptoms are emaciation, 
weakness, indigestion, and purpura. The gums are 
swollen and bleed easily, the teeth are loosened, the 
tongue is swollen, the breath is foul, and in children, 
especially, the lower ends of the femur and the tibia 
are swollen from subperiosteal bleeding. 

Nursing. — Frequent cleansing, scrupulous care of 
the mouth, and the provision of fresh air and of food 
rich in salts, especially fruit juices, are the main points 
in the treatment. 



A Synopsis of Important Diseases 433 

Diseases of the Thyroid Gland 

Goitre. — Goitre is rare in this country, but it is par- 
ticularly common in Switzerland. It is supposed to 
be due (i) to the drinking of waters containing a 
large amount of magnesium limestone, 1 and (2) to 
infection. 

Symptoms. — There is a tumour on one or both 
sides or in the middle of the neck. The general health 
is not, as a rule, much affected. 

Exophthalmic Goitre. — Exophthalmic goitre is 
known variously as Parry's, Graves's, and Basedow's 
disease. The thyroid is enlarged and the blood-vessels 
are dilated. The pulse is generally very rapid. 
There are breathlessness on exertion, exophthalmos, 
i. e., abnormal protrusion of the eyeballs; extreme 
nervousness; and general dyspeptic symptoms. 

Myxcedema. — Myxcedema is supposed to be due 
to the absence of thyroid secretion. 

Symptoms. — The entire body looks swollen, the 
skin becomes dry and rough, the hands broad, the 
expression stupid, the hair thin and brittle. The 
onset of the condition should be recognised, as treat- 
ment, to be of much benefit, must be begun early in 
the disease. 

Enlargement of the Spleen. — The spleen is 
temporarily enlarged in the majority of infectious 
diseases. It becomes permanently enlarged in chronic 
malaria, leukaemia, cirrhosis of the liver, and splenic 
an mia. 

Diseases of the Digestive Organs 

The Mouth — Acute Glossitis. — Acute glossitis 
sometimes follows abrasions of the tongue. It ma}' 



' Such water can be rendered harmless by boiling. 



28 



434 Practical Nursing 

be due either to infection, or to a general run-down 
condition of the system. The tongue becomes in- 
flamed and cracked, There is dysphagia, salivation,, 
and, in severe cases, dyspnoea, cyanosis, and fever. 

Aphthous Stomatitis. — Aphthous stomatitis is 
more common in young children than in adults. It 
usually occurs in connection with fevers or other in- 
dispositions, especially when the mouth has not been 
properly cleansed. Small ulcers form on the inner 
surface of the cheeks and lips, and along the edge of 
the tongue. 

Gangrenous Stomatitis. — Gangrenous stomatitis 
occasionally follows infectious diseases; or it may 
be due to the uncleanliness of the mouth, especially 
where there is a general debility of the system. It 
begins as an ulcer, but gangrenous sloughs rapidly 
develop. There is a high fever, and general septic 
condition. About 80% of such cases die within a 
couple of weeks. 

"Parasitic Stomatitis (Thrush). — Parasitic stoma- 
titis is caused by the Oidium Albicaus, yeast fungus. 
It is seen in poorly nourished babies, when the 
mouth has not been properly cared for. It may 
also be the result of dirty nipples, feeding-bottles, 
etc. It occasionally occurs in adults, when there is 
a general debility of the system, especially after 
long illness. A white fungus appears on the tongue, 
and the mouth is dry and sore. The saliva has an 
acid reaction. 

Ulcerative Stomatitis. — Ulcerative stomatitis 
is due to certain poisonings, notably, lead, mercury, 
and phosphorus. It is also caused by scurvy and 
lack of cleanliness. The gums are swollen and red, 
and they bleed easily. Ulcers form along the edge 



A Synopsis of Important Diseases 435 

of the teeth, the teeth loosen, and there is salivation. 

Xursing. — Careful cleansing of the mouth before 
and after each meal is imperative in all the above 
diseases of that organ (see Chapter VI. ^ . In any severe 
disorder the patient is often fed by nasal gavage, 
and care must be taken to pass the tube well into 
the oesophagus so that the liquid will not get into 
the mouth. 

The Stomach — Carcinoma of the Stomach. — The 
predisposing causes of this trouble are hereditary 
tendency, chronic gastritis, ulcer or other disease of the 
stomach. In addition to the physical symptoms, 
which are frequently lacking, till the disease is far ad- 
vanced, there is a gradual failure of the general health, 
pain in the stomach and back, and rapid emaciation, 
followed by vomiting of undigested food, and, as the 
disease advances "coffee-ground," vomitus. After a 
a test breakfast, the result of the siphonage contains 
an abundance of lactic and fatty acid, but the HC1. 
is diminished or entirely absent. 

Prognosis. — The disease is generally fatal within a 
year. 

Dilatation of the Stomach. — Dilatation of the 
stomach generally occurs as a complication or sequela 
to some other disease of the stomach, especially to 
pyloric obstruction and chronic gastritis. The stomach 
holds an abnormally large amount of food which 
accumulates there, and ferments, causing eructations 
of gas, and the vomiting, every few days, of large 
amounts of sour foul-smelling matter. 

Gastric Neurosis. — Gastric neurosis often com- 
plicates nervous disorders. The three most common 
forms are: 

i. Motor neurosis, in which there is a super- 



43 6 Practical Nursing 

motility of the stomach which causes it to discharge 
its contents too quickly. There are nervous eructa- 
tions of gas, and often vomiting, almost immediately 
after meals and without nausea. 

2. Secretory neurosis, which affects the secretory 
functions of the stomach. In some cases, the per- 
centage of HC1. in the gastric juice is increased 
during digestion; in others, it is diminished; and in 
still others, there is either an increase or decrease 
of the total amount of gastric juice. 

3. Sensory neurosis. In this, there may be: 
gastrologia, the pain of which resembles that of 
gastric ulcer; hyperesthesia, which w T ill cause a 
sense of fulness and burning in the epigastrium; or 
nervous anorexia, which often leads to an extreme 
distaste for food, resulting in emaciation and a general 
lowering of the body vitality. In the majority of 
cases, all three forms are present, and there may be 
marked variations in the symptoms. 

Gastritis. — Gastritis is an inflammation of the 
lining membrane of the stomach. It may be acute, 
chronic, membranous, phlegmonous, or toxic. The 
first is commonly caused by an excess of food, bad 
food, irritating drugs or micro-organisms. It may 
also complicate various diseases. Chronic gastritis 
is most commonly caused by excessive eating, im- 
proper mastication of food, indigestible food, drugs, 
over-indulgence in alcohol, tea, or coffee. It also 
frequently accompanies chronic diseases. 

Ulcer of the Stomach. — Ulcer of the stomach 
occurs most frequently in young women who are 
badly fed. There is pain in the epigastrium and 
vomiting. The latter is sometimes the first symptom. 
The vomitus is usually pure blood. 



A Synopsis of Important Diseases 437 

Nursing. — In all disorders of the stomach, the 
diet is of course of primary importance. In severe 
cases the patient is generally ordered such liquids as 
whey, barley water, etc. When he is allowed to have 
solid food, it must be carefully cooked that it 
may be as digestible as possible. Only such things 
should be given as the doctor orders. 

The Intestines — Appendicitis. — Appendicitis is 
inflammation of the vermiform appendix. It may 
be caused by infection, or by irritation due to ob- 
struction in or around the appendix. An attack 
may come on gradually, with constipation, nausea, 
and increasing abdominal pain; but, as a rule the 
onset is sudden with severe abdominal pain, either 
localised or general, nausea, and obstinate constipa- 
tion. Within forty-eight hours, the pain generally 
becomes localised to the right iliac region, the tem- 
perature rises from ioi°-io3° P., and there is some- 
times a high leucocytosis. 

Recovery may take place in a few days; or the 
condition may persist and go on to ulceration, necrosis, 
gangrene, or abscess formation, which will be fol- 
lowed, unless operative measures are resorted to, by 
perforation and peritonitis. 

Nursing. — The application of ice-bags over the 
region of the appendix is a frequent treatment. 
These, to be of any use, must be kept continuously 
cold. It is as important to keep the patient quiet 
before operation as after and to move him very care- 
fully. Any sudden movement might rupture the 
abscess and cause a general peritonitis. 

Cholera Infantum. — The most frequent causes 
of cholera infantum are improper food and feeding, 
dirty surroundings, and bad air. It is usually ushered 



43 s Practical Nursing 

in by some intestinal disturbance. The temperature 
rises from 103-105 F., the pulse becomes frequent and 
feebte, the tongue coated, the mucous membranes 
dry, the face pallid and shrunken, and the surface 
of the okin cold. The stools are at first diarrhoeal, 
but, after a few hours, become frequent and watery 
with little smell. There is incessant vomiting and 
colic. 

Nursing. — In nursing such cases, the tendency to 
collapse must be remembered and guarded against. 
The child must be kept warm, its food must be care- 
fully prepared and given in small amounts, sometimes 
only in drachm doses, at regular intervals. 

Colic — Colic is due to an accumulation of gas in the 
stomach and intestines. Pain is relieved on pressure. 
The most frequent causes are overfeeding or improper 
feeding, and cold feet. It will often be relieved by 
the application of hot stupes to the abdomen. 

Acute Colitis. — There are two types of acute 
colitis. In the more common type, the onset is sudden 
with abdominal pain and large, watery movements. 
The pain is in the lower abdomen, and just precedes 
the movement. The movements are mostly watery, 
contain undigested food and a little mucus. General 
prostration and, if stools continue, emaciation result. 

In the other type, the onset is sudden with frequent 
passages of bloody mucus, at times pure blood which 
looks like currant jelly. There is severe tenesmus 
and sometimes abdominal pain. 

Treatment.- — For either type, the first thing to be 
given is castor-oil. In type one, this is followed by 
large doses of bismuth, also Dover's powder. In type 
two, irrigations, diet liquids, and bed till stools are 
normal help most. Type two is more often protracted. 



A Synopsis of Important Diseases 439 

Chronic Colitis. — Chronic colitis is similar to type 
one, if it is in the upper bowel; similar to type two, 
if in the rectum and sigmoid. 

Diarrhceas of Children. — Diarrhoeas of children 
are especially common during the summer months. 
The most usual causes are overfeeding, improper 
feeding; sour milk, infected milk, milk containing too 
much casein or fat, dirt, and bad air. The stools are 
watery but faecal, and are greyish or green in colour. 
In bad cases, they may be frothy or contain blood. 
The disease is protracted, and it may be weeks before 
the intestines are in a normal condition. 

Treatment. — The milk is generally stopped for a 
few days, and barley water given in its stead. A 
cathartic is administered to clear the intestine of 
irrigating substances. Fresh air is of the utmost 
importance and, even when in bed, the child should, if 
possible, be kept in the open air. As improvement 
takes place, milk is added to the feedings in gradually 
increasing amounts. 

Dysentery. — For dysentery, see " Infectious 
Diseases." 

Enteritis. — The common causes of enteritis are 
improper food, impure drinking water, anaemia, and 
infectious diseases. There are intestinal colic, tym- 
panites, diarrhoea, and nausea. The patient generally 
lies with the knees drawn up, seeking relief from pain 
by relaxing the abdominal muscles. Heat and ab- 
dominal pressure will often afford relief. 

Nursing. — The usual treatment consists of the 
application of hot fomentations or a hot-water bag 
to the abdomen, and the administration of a strong 
cathartic to rid the intestine of the irritating sub- 
stance. The cathartic is sometimes followed by a 



44° Practical Nursing 

hot rectal injection, or by a few doses of bismuth, if 
the diarrhoea is not checked. Rest in bed , and a boiled 
milk diet is imperative. If the condition is neglected, 
a severe illness may ensue. 

Intestinal Obstruction. — The most common 
causes of intestinal obstruction are: strangulation 
of the intestine; strictures, due to cicatricial scars; 
pressure from new growths; and impaction from faeces, 
gall-stones, etc. In children, intussusception (the tele- 
scoping of one part of the intestine into another) may 
also be a cause. 

Symptoms. — The symptoms of intestinal obstruction 
are acute abdominal pain and increasing abdominal 
distention, constant vomiting of vomitus that grad- 
ually assumes a faecal odour, absolute constipation, 
cold clammy skin, shallow breathing, marked pros- 
tration, frequent feeble pulse, and leucocytosis, but 
no fever. 

Nursing. — Keep the patient in bed and give 
nothing by mouth unless ordered by the doctor. 
High enemas, with the patient in the knee-chest 
position, if possible, and rectal irrigation, are generally 
tried. If these fail operative measures are resorted to, 
as otherwise the condition generally proves fatal in 
a few days. 

The Peritoneum — Ascites. — Ascites is a collec- 
tion of fluid in the peritoneal cavity. The most 
frequent causes are: such cardiac, renal, or blood 
conditions as cause dropsy in other parts of the body ; 
cirrhosis of the liver ; portal obstruction ; obstruction of 
the lymphatics; abdominal tumour, and tumours of 
the peritoneum. 

Acute Septic Peritonitis. — Acute septic perito- 
nitis is inflammation of the peritoneum. The most 



A Synopsis of Important Diseases 44 l 

common causes are: perforation in appendicitis, 
gastric ulcer, and typhoid; rupture of an abscess of 
the kidneys, liver, ovaries, or tubes; extension of 
inflammation of any of the abdominal organs; and 
infected abdominal wounds. 

Symptoms. — The usual symptoms are a rise of 
temperature, frequent, feeble, irregular pulse, rapid 
respiration, nausea, projectile vomiting of dark, 
greenish - brown vomitus, hiccough, constipation, 
tympanites, and in severe cases delirium or stupor. 
When the peritonitis is due to perforation, these 
symptoms are preceded by a sudden intense abdominal 
pain followed by a fall of temperature and accelerated 
pulse. 

Nursing. — The patient must be kept quiet. Fre- 
quent sponging and rubbing with alcohol is one of 
the surest means of obtaining this result. A cradle 
should be placed under the bed-clothes when their 
weight causes discomfort. 

Chronic Peritonitis. — Chronic peritonitis may 
be simple or tuberculous. The septic condition is 
lacking, and the disease runs a longer course. 

The Liver — Abscess of the Liver. — There are 
two varieties of abscess of the liver, the amoebic, and 
the septic. The former follows, or is associated with, 
amoebic dysentery. It is more prevalent in tropical 
climates. 

In the septic form, the infection may be due 
to any of the bacilli which promote suppuration. 
They may reach the liver either through the hepatic 
artery or vein, the portal vein, the gall ducts, from a 
wound extending, to the liver or from a wound of 
the contiguous organs or tissue. The symptoms 
are those of sepsis associated with pain in the 



44 2 Practical Nursing 

liver. Operative measures are generally resorteti 
to. 

Carcinoma of the Liver. — Carcinoma of the 
liver seldom occurs as a primary growth, but generally 
follows cancer of some other organ of the body. 

Symptoms. — In addition to the physical sign, i.e., 
the presence of the tumour, the usual symptoms of 
cancer are cachexic, more or less pain, jaundice, and 
leucocytosis. The fever is variable. 

Cirrhosis. — Cirrhosis of the liver is most fre- 
quently the result of intemperance in either drinking 
or eating, particularly the former. Syphilis, rickets, 
tuberculosis, cancer, and many of the infectious 
diseases are also predisposing causes. The connective 
tissue of the liver is thickened, and the functions of the 
liver are interfered with. This results in many con- 
stitutional disturbances. Ascites is the most fre- 
quent complication. 

There are six forms of the disease: 

i. Atrophic cirrhosis, associated with atrophy 
of the liver. 

2. Biliary cirrhosis, in which there is chronic re- 
tention of bile. 

3. Capsular cirrhosis, associated with syphilis, 
interstitial nephritis, etc., in which the liver is atro- 
phied and the capsule much thickened. 

4. Fatty cirrhosis, in which the hepatic cells 
become infiltrated with fat. 

5. Hypertrophic cirrhosis, in which the liver is 
hypertrophied. 

6. Syphilitic cirrhosis, due to syphilis. 

Fatty Liver. — Fatty infiltration of the liver is 
generally the result of over-indulgence in eating 
and in alcoholic drinking. It also fojlows chronic 



A Synopsis of Important Diseases 443 

phosphorus poisoning, severe anaemia, cancer, and 
tuberculosis. 

There are no severe constitutional symptoms asso- 
ciated with the condition. 

Gall-Bladder and Ducts — Cholecystitis. — 
Cholecystitis is acute inflammation of the gall-bladder. 
In light cases, there is simply a catarrhal condition 
of the cystic duct and gall-bladder. In severe cases 
— suppurative cholecystitis — the cystic duct is almost 
closed and the bladder is distended with pus. 

Symptoms. — In addition to the symptoms of general 
sepsis, there will be severe vomiting, constipation, 
and abdominal pain. There is seldom any jaundice. 
Cholecystitis is very often mistaken for appendicitis. 

Cholelithias (Gall-Stones) . — Cholelithias is 
generally due to the entrance of bacteria into the gall- 
bladder, which start a catarrh of the mucous mem- 
brane that results in the secretion of an increased 
amount of cholesterin and lime salts. The stones 
may vary in number from a single one to many hun- 
dreds. They may be black, white, or any inter- 
mediate shade, and they are usually either ovoid or 
spheroidal in shape. They may form or lodge in the 
gall-bladder, the cystic duct, the common duct, or 
the intestine. 

Biliary or Hepatic Colic — Biliary colic occurs 
during the passage of a stone from the gall-bladder. 
During the attack, there is intense paroxysmal ab- 
dominal pain., together with nausea and vomiting. As 
vomiting may relieve the pain, it is often induced. 
There may be chills and fever. The pulse is generally 
rapid and weak, and the skin is covered with a cold 
perspiration. 

Jaundice. — Jaundice is a symptom rather than 



444 Practical Nursing 

a separate disease. The three most frequent causes 
of this condition are : 

i. Obstruction of the bile ducts. This obstruction 
may be caused by: inflammation of the duct or of 
the duodenum ; impaction of the duct by gall-stones, 
or other foreign bodies; cancer of the duct or duo- 
denum ; or pressure upon the same by tumours of any 
of the contiguous organs. 

2. Toxaemic poisoning. This may be due to 
certain infectious diseases, such as yellow fever, per- 
nicious malaria, and pyaemia, or to certain poisons, 
such as phosphorus, arsenic, mercury, snake- venom, etc. 

3. Shock or excessive emotion. 

In protracted cases of jaundice, the blood and all 
the tissues, with the exception of nervous tissue, con- 
tain bile and it is given off in the urine and perspira- 
tion. When jaundice is due to obstruction, the stools 
are clay-coloured and very foul. 

Bile in the blood impairs, in a greater or less extent, 
its coagulable property. There is, therefore, an 
increased danger of haemorrhage after injury or 
operation, when there is any degree of jaundice. 

Bile is the great emulsifler of fat. Fat, therefore, 
should be withheld from the diet when there is jaun- 
dice, as there cannot then be sufficient bile in the 
intestine to digest the fat. 

Icterus Neonatorum. — Icterus neonatorum is 
the name given to the jaundiced condition very fre- 
quently present in new-born infants. It appears 
about the second or third day. In mild cases, the 
jaundice disappears in a few days. In severe cases, it 
may be due to congenital stenosis, constriction of the 
hypathic duct, syphilis, or septic infection of the cord. 

The Pancreas — Abscess of the Pancreas. — Ab- 



A Synopsis of Important Diseases 445 

scess of the pancreas is generally the result of obstruc- 
tion of the duct. There is septic fever, jaundice, 
and diarrhoea. Surgical treatment is fairly successful. 

Carcinoma of the Pancreas. — In carcinoma of the 
pancreas, there is marked and persistent jaundice. 
The stools show lack of pancreatic secretion. The 
patient suffers from severe attacks of pain associated 
with nausea, flatulence, faintness, cold clammy skin, 
and other symptoms of collapse. 

Pancreatic Calculi. — In a case of pancreatic 
calculi there are sharp attacks of pain, as in carcinoma 
bi the pancreas, but there is no jaundice. The stones 
lodge in the duct and cause dilatation of the same, 
and sometimes even a fistula into the stomach or 
peritoneal cavity. They may result in pancreatic 
abscess, and they predispose to carcinoma and the 
formation of cysts. 

Pancreatitis. — Pancreatitis is inflammation of 
the pancreas. Obstruction of the duct is its most 
common cause. The condition may be either acute 
or chronic. There are three varieties of the acute 
form, suppurative, haemorrhagic, and gangrenous. 
They are generally fatal. 

Nursing. — As the condition of the stools is generally 
of diagnostic value in diseases of the pancreas, they 
must be always carefully inspected when such dis- 
orders are suspected and any abnormality reported 
or the stool saved for the doctor's inspection. The 
tendency to sudden collap.se also must be remem- 
bered and watched for. 

Diseases of the Urinary Tract 

The Kidneys — Dropsy ((Edema). — Dropsy, or 
oedema, was at one time thought to be a disease, 



44 6 Practical Nursing 

but it is now recognised as a symptom of many of 
the diseases which affect the kidneys and the circu- 
lation. It is characterised by an excess of liquid in 
one or more of the serous cavities of the body, or in 
the areolar tissue. It may be either general or local. 

General oedema is known as anasarca. ' 

If the liquid collects in the abdominal cavity, it is 
called ascites. 

If the liquid collects in the pleural cavity, it is 
called hydrothorax. 

If the liquid collects under the pericardium it is 
called hydropericardium. 

If the effusion is into a joint it is known as 
hydrarthrus. 

If the cerebro-spinal fluid increases sufficiently to 
enlarge the head, it is known as hydrocephalus. 

The most dangerous sites are the throat (oedema 
of the glottis), the brain, the lung, the heart, and the 
serous sacs. 

Congestion of the Kidneys. — Congestion of the 
kidneys may be caused by cantharides, turpentine, 
cubebs, copaiba, by anaesthetics, especially ether, 
and by chilling of the skin. 

Symptoms. — The symptoms are lumbar, pain, 
malaise, and slight fever. The urine is diminished in 
quantity, dark coloured, and of high specific gravity 
and generally contains a slight amount of albumin. 
Unless nephritis follows, the condition will, with care, 
be relieved in a few days. 

Chronic Congestion of the Kidneys. — Chronic 
congestion of the kidneys frequently complicates 
disease of the heart, lungs, and liver. 

Floating Kidney. — Floating kidney is generally 
due to: the disappearance of perirenal fat; increased 



A Synopsis of Important Diseases 447 

weight of the kidney; congenitally lax peritoneal 
attachment, with long renal arteries and veins; or 
tight lacing. 

Symptoms. — The symptoms are pain in the lumbar 
region, and mental depression. Neurasthenia, dyspep- 
sia, and abdominal colic are also frequently present. 
In bad cases, there may be chills and fever and con- 
stant vomiting. 

Operative measures are frequently required for the 
relief of this condition, but it can sometimes be 
remedied by constantly wearing a suitable pad and 
belt. 

Acute Nephritis (Acute Bright's Disease.) — 
Acute nephritis is an acute inflammation of the kidney. 
It may result from exposure to cold and wet, ex- 
tensive burns, or diseases which have interfered with 
the function of the skin. It is a very common com- 
plication of scarlet fever, diphtheria, and other acute 
infectious diseases. It sometimes occurs in pregnancy 
and sometimes follows the use, in excess, of arsenic, 
carbolic acid, cantharides, iodoform, mineral acids, 
lead, phosphorus, and mercury. 

As a sequela to skin diseases or burns, nephritis 
generally occurs late, often in convalescence. It may 
come on very suddenly. In pregnancy, however, its 
onset is slow, and it is a very serious complication. 

Symptoms. — Chills or convulsions frequently mark 
the onset. The fever varies from ioi° to 103 F., the 
skin being pale and dry. (Edema may be quite 
marked in a few hours. There is albumin in the 
urine. 

The usual treatment is: to keep the patient in bed; 
to administer daily saline purges, hot packs or other 
measures to produce sweating; to insist upon a milk 



44 8 Practical Nursing 

diet, and to provide, when the oedema is not marked, 
copious drinks of water. 

Chronic Nephritis (Chronic Bright's Disease). — 
There are two varieties of chronic nephritis: paren- 
chymatous, the inflammation of the substance proper 
of the kidney; and interstitial, the inflammation 
of the connective tissue of the kidney. In the former, 
the kidney is enlarged; in the latter, it is usually 
atrophied. 

Symptoms of Parenchymatous, Nephritis. — Paren- 
chymatous nephritis may follow acute nephritis. 
The symptoms in the latter abate somewhat, but 
the anaemia, dropsy, and albuminuria persist and 
gradually become more marked. Parenchymatous 
nephritis may come on insidiously with headache, 
gastro-intestinal disturbances, anaemia, dropsy, and 
urinary and cardiovascular changes. The quantity of 
urine voided is diminished, it is of a dark colour, has a 
heavy sediment, and contains albumin. Sometimes, 
there is albuminuric retinitis. Attacks of uraemia 
may occur at any time and often cause a fatal term- 
ination of the disease. Patients frequently die in six 
months to a year; but the disease may drag on for 
several years with exacerbations or with no symptoms 
except an occasional albuminuria. 

Treatment. — A warm, equable, climate is generally 
advised, but draughts or sudden chilling of the skin 
must be guarded against. The patient should be 
out of doors as much as possible. Saline cathartics 
and diaphoretics are frequently given, as in acute 
nephritis, and, when oedema is not marked, copious 
drinks of water. Meats, meat broths, and extracts 
are given sparingly at all times and are withheld 
entirely during acute attacks (see Chapter XXIV.). 



A Synopsis of Important Diseases 449 

Symptoms of Interstitial Nephritis. — In interstitial 
nephritis, the quantity of urine voided is increased. 
It is of pale colour, and low specific gravity. Albumin 
is often present, but not in large amounts, nor does it 
persist as in the parenchymatous type. There is 
frequently dimness, or other disturbance, of vision. 
General oedema is not so common as oedema of the 
lungs. Acute attacks of uraemia are not infrequent. 

Treatment. — The main points of the treatment are 
much the same as in the parenchymatous type. 

Nephrolithiasis (Stone in the Kidney). — 
Stones are formed in the kidneys by the aggregation of 
solid substances precipitated from the urine in the 
pelvis of the ureters. This precipitation is partly 
caused by an excess in the urine of the substance pre- 
cipitated and, partly, by some abnormality in the 
condition of the urine, which makes it less soluble. 

Symptoms. — Gravel and even fairly large stones, 
may be passed for a long time and give no definite 
symptoms; or there may be more or less pain in the 
kidneys. If, in its passage, the stone becomes im- 
pacted in any of the ducts, "renal colic" will ensue. 
The onset is generally abrupt, there is an intense, 
agonising pain which radiates along the ureter, there 
may be a chill followed by fever ioo° F. ; the skin is 
cold, pale, clammy, and covered with perspiration. 
Frequent, painful micturition is common. The attack 
may only continue a few hours, or it may persist with 
or without intermission for some days. There may 
be blood in the urine for some days after an attack. 
There may be repeated attacks of renal colic, or but 
a single one. Congestion of the kidney or pyelitis 
may complicate the condition, or there may be no 
marked ill-health between attacks. 



45° Practical Nursing 

Treatment. — For the colic, hot baths are often 
ordered and copious hot drinks. Morphine is gener- 
ally given for relief of pain. 

Perinephritic Abscess (Abscess of the Kidney). 
— Perinephritic abscess may be caused by trauma, 
it may follow infectious fevers, or may be the result 
of infection from perforation of the appendix, colon, 
or pleural . abscess. The onset is sometimes sudden, 
but more commonly it comes on gradually. There 
is continuous pain over the kidney and the usual 
symptoms of sepsis. 

Pyelitis. — Pyelitis is an inflammation of the 
mucous membrane lining of the pelvis of the kidney. 
The condition may vary from that of a slight con- 
gestion and mild catarrh, to necrosis and suppuration. 

Tumours. — The kidneys are sometimes the seat of 
tumours, both malignant and benign. 

Uremia. — Uraemia is a toxic condition supposed 
to be due (i) to retained excrementitious matter that 
the kidneys have failed to eliminate and (2) to per- 
verted metabolism, in consequence of which abnormal 
compounds that act as poisons have been formed. 
It sometimes complicates nephritis and anuria. 

It is characterised by headache, vomiting, dyspnoea, 
Cheyne-Stokes respiration, coma, and convulsions. 

The Bladder — Cystitis. — Cystitis is inflamma- 
tion of the mucous membrane of the urinary bladder. 
The most common causes are: germ infection, irrita- 
tion by an excessive or improper use of the catheter, 
cold, poisoning by cantharides, etc. Cystitis due 
to germ infection is generally the result of unsterile 
catheterisation. The condition is exceedingly hard 
to cure. It has a strong tendency to become chronic, 
in which case it is the cause of endless suffering to the 



A Synopsis of Important Diseases 45 l 

victim. Therefore, too great stress cannot be laid 
upon the necessity for absolute cleanliness and perfect 
sterilisation of everything used for the operation 
and of the nurse's hands. To prevent the too fre- 
quent use of the catheter, the instructions given in 
Chapter XI. regarding the methods of making a 
patient void urine voluntarily must be remembered 
and resorted to. 

Diseases of the Uterus and Appendages 

Exact diagnosis of the various diseases of the uterus 
and its appendages is made chiefly by vaginal examin- 
ation, the symptoms being much the same regardless 
of the organ effected : viz. ; pain in the lumbar region 
and lower part of the abdomen, nervousness, fre- 
quently a vaginal discharge, the nature of which 
assists in diagnosis; menorrhagia, and, if pus is pres- 
ent, more or less marked septic symptoms. 

The Uterus — Anteversion. — This is a pushing 
forward of the uterus, a condition generally due to the 
presence of some mass behind it. The most pronounced 
symptoms are dysuria and irritability of the bladder. 

Anteflexion. — A bending forward of the uterus 
upon itself. 

Endometritis. — Endometritis (from the Greek 
words, "endo, " within, and "metra, " uterus, and the 
termination "itis" meaning inflammation) is an in- 
flammation of the membrane lining the uterus. 

Laceration of the Cervix Uteri. — Laceration of 
the cervix uteri is a tear of the neck of the uterus. 
This usually occurs during confinement. 

Metritis (Inflammation of the Uterus). — 
Septic metritis is most commonly caused by infection 
during or after labour. 



45 2 Practical Nursing 



Prolapse. — Prolapse is a falling down of the uterus, 
generally due to loss of tone and relaxation of the 
uterine ligaments. 

Retroversion. — Retroversion is a backward dis- 
placement of the uterus. The distinctive symptoms 
are a feeling of weight and bearing down of the pelvis, 
which is aggravated by standing menorrhagia and 
leucorrhea. 

Tumours. — The uterus and its appendages are 
frequently the seat of tumours. They may be cystic — 
that is containing fluid, such are known as cysts, — or 
solid; malignant, that is of a virulent nature, such 
as sarcoma, or benign. 

The most common benign tumours are: 

Angeioma, a tumour formed of blood-vessels. 

Dermoid or dermatoid, a cyst or tumour containing 
hair, bone, etc., these more often occur in the ovaries. 

Myoma, a muscular tumour. 

Polypus, a pedunculated tumour. 

Sebaceous cyst, a retention cyst of a sebaceous 
gland. 

The Vagina and Perineum — Cystocele. — Cys- 
tocele is prolapse or relaxation of the anterior wall of 
the vagina including the bladder. 

Rectocele. — Rectocele is prolapse of the posterior 
wall of the vagina, including the rectum. 

Vaginitis. — Vaginitis is inflammation of the vagina. 
For vaginitis due to gonorrhceal infection, see " In- 
fectious Diseases," page 356. 

Laceration of the Perineum. — Laceration of 
the perineum is a tear in the perineum. When the 
tear extends through the sphincter muscle of the 
rectum, it is known as complete laceration; when it 
is not so extensive, as partial laceration. 



A Synopsis of Important Diseases 453 

Care of Perineorrhaphies. — Perineorrhaphy is 
the suturing of the perineum. 

There are, perhaps, no surgical cases which require 
more care than perineorrhaphies, or in which the 
success of the operation depends so largely upon the 
nursing. For the first forty-eight hours and longer, 
if the patient is restless, the knees should be bound 
together to avoid any strain on the stitches when the 
patient moves. If there is the slightest straining 
during defecation, put on a sterile rubber glove, or 
wrap the hand in sterile gauze, and hold the sutured 
parts together. Some surgeons require oil enemas 
to be given before each defecation to soften the 
faecal matter. Besides the danger of the stitches 
being broken by straining, there is that of infection 
to avoid which latter, the stitches and surrounding 
tissues must be most carefully irrigated and dried 
after every defecation and micturition. The irriga- 
tion can be done either with a syringe or with the 
douche apparatus, using a glass pipette instead of a 
douche nozzle. Regulate the flow of water so that 
it is very gentle, and be sure to remove all foreign 
substance. Dry the parts thoroughly by gently pres- 
sing sterile sponges against the surface. Apply a 
sterile gauze dressing, cover with a sterile pad, and 
keep in place with a T binder. To avoid irritating 
the stitches, many surgeons require perineorrhaphy 
patients to be catheterised for at least twenty-four 
hours after the operation. 

When douches are ordered it is generally better 
to substitute a straight glass catheter for the ordinary 
douche nozzle. 

Abnormalities Attending Menstruation — Am- 
enorrhcea. — Amenorrhcea is absence of menstruation. 



454 Practical Nursing 

It is physiological before puberty, after the menopause, 
and during pregnancy and lactation. The patholo- 
gical causes are: changes of climate or occupation; 
psychical disturbances; catching cold; getting the feet 
wet ; sea-bathing or over-exertion during menstruation ; 
such diseases as chlorosis, the infectious fevers, chronic 
nephritis and diabetes, myxcedema and Addison's 
disease. 

The only symptom may be absence of the discharge ; 
but, if the trouble is long continued, psychical symp- 
toms such as hysteria, melancholia, and even a species 
of dementia may occur at the menstrual period. 

Attention to the general health is the main feature 
in the treatment. 

Menorrhagia. — Menorrhagia is an excessive or 
prolonged menstruation. Endometritis, sclerosis of 
the uterine blood-vessels, tertiary syphilis, malignant 
disease, tuberculosis, the presence of tumours, etc., 
are the most common causes. 

Metrorrhagia. — Metrorrhagia is a bleeding from 
the uterus at frequent irregular intervals; the causes 
are the same as those of menorrhagia. 

Dysmenorrhea. — Dysmenorrhcea is painful men- 
struation. There are pain in the pelvis and back 
and general nervous symptoms during the first twelve 
to thirty-six hours of the flow. In severe cases, there 
may be nausea, vomiting, hysterical convulsions, or 
syncope. The common causes are ill development of 
the uterine blood-vessels, a narrow cervical canal, 
obstruction of the cervical canal, anteflexion of the 
uterus hyperaesthesia of the lining membrane of the 
uterus and nervous disorders. 

Treatment. — The general health must receive at- 
tention, especially the nervous condition. A laxative 



A Synopsis of Important Diseases 455 

should be given just before the beginning of the period 
and the patient kept in bed for the first twelve hours. 
Local treatment or operative measures are some- 
times necessary. 

The Fallopian Tubes — Extra-Uterine Preg- 
nancy. — Extra-uterine pregnancy is pregnancy which 
occurs outside the uterus. This most frequently 
happens in the tubes and is known as tubal pregnancy. 
When it occurs in the abdominal cavity it is called 
abdominal pregnancy. 

Hematosalpinx. — Hematosalpinx is haemorrhage 
into the Fallopian tubes. 

Hydrosalpinx. — Hydrosalpinx is a form of tubal 
inflammation in which there is an accumulation of 
serous fluid in the tubal canal. 

Pyosalpinx. — Pyosalpinx is pus in the Fallopian 
tubes, due to infectious salpingitis. 

Salpingitis. — Salpingitis is inflammation of the 
tubes. It may be either infectious or non-infectious. 
The latter type may result from cold, injuries, the 
introduction of irritating substances into the uterus 
or tortuosity of the tube. Infectious inflammation 
is the more common. The gonococci are the most fre- 
quent cause of the infection and, next the streptococci. 

The Ovaries — Abscess of the Ovary. — Abscess 
of the ovary is a collection of pus in the ovary. 

Oophoritis (Ovaritis). — Oophoritis is inflamma- 
tion of the ovary. This is generally due to microbic 
infection. The most common infection are the strep- 
tococci, resulting from puerperal infection, and the 
gonococci. 

Diseases of the Muscles 

Myositis. — Myositis is inflammation of the muscles. 
It is characterised by pain, swelling, and loss of func- 



45 6 Practical Nursing 

tion. Myositis may be local or universal. The latter 
begins in the lower extremities and ascends, involving 
other muscles. Atrophy may occur and the muscles 
become more or less rigid. The progress is gradual. 
Death occurs when the respiratory muscles become 
involved. 

Muscular Rheumatism. — See ''Rheumatism," 
page 406. 

Diseases of the Bones 

The principal diseases of the bones are the fol- 
lowing : 

1. Caries — ulcerous inflammation of bone. 

2. Necrosis — death of bone. This is always due 
to injury of the periosteum, which shuts off the 
supply of blood from the bone. 

3. Osteoma — a bony tumour. 

4. Osteomyeli is — inflammation of the marrow of 
the bone. This is one of the most important diseases 
which attack the bones. There are tenderness, redness, 
and swelling over the point of suppuration. There 
is usually high fever, and there may or may not be 
chills. 

5. Osteonecrosis — necrosis, or death of bone. 

6. Osteoperiosteitis — inflammation of both bone 
&nd periosteum. 

•7, Ostitis or osteitis— inflammation of the bone. 

Diseases of the Skin 

Acne. — Acne is one of the most common skin 
diseases. It most frequently appears about the time 
of puberty, and is apt to run a chronic course until 
the body is fully developed, after which there is a 
tendency to recovery. The disease is characterised 



A Synopsis of Important Diseases 457 

by small papules, or, in the pustular type, pustules, 
around the mouth of the sebaceous glands and hair 
follicles. It is supposed to be due to the clogging of 
the sebaceous glands by an over-secretion and in- 
spissation of fat. Any form of indigestion or mal- 
nutrition is apt to increase the trouble. Therefore, 
a wholesome, not too rich, easily digested diet, 
regulation of the bowels, absolute cleanliness, and 
exercise are of the utmost importance. No local ap- 
plications ever avail, so long as these essentials are 
neglected. 

Eczema. — Eczema is a non-contagious, inflam- 
matory disease of the skin attended with itching, 
desquamation, and, usua 1 ly, the exudation of serous 
or sero-purulent fluid. 

Nursing. — It is important in all forms of eczema 
to keep the skin dry. Many physicians will only 
allow of the affected parts being cleansed with oils 
or prescribed ointments. The exclusion of the air 
is also necessary; this can be obtained by bandaging 
lint, etc., lightly over the part, or if the head is the 
seat of the disease, a cap of lint can be made; if the 
face, a mask. A mask can be more easily retained 
in place if the lint is cut large enough to come well 
up on the head and under the chin and a couple of 
darts taken on the head and under the chin. Holes 
are cut for the eyes, and of the nose, and mouth. 
These holes should not be larger than necessary. The 
mask can be either bandaged or tied on. 

Epithelioma. — Epithelioma is cancerous growth 
in the skin. 

Erythema. — There arj several varieties of ery- 
thema. Two of the most common are: i. Erythe- 
ma hyperaemicum- This is a simple reddening of the 



45 8 Practical Nursing 

skin in localised patches due^ to irritation either in- 
ternal or external. In some people it is caused by 
eating some partcular food such as fish, etc. 2. 
Erythema intertrigo. This is an eruption which 
occurs between two folds of skin in fat peop 1 e and 
babies. It should be treated by keeping the part 
dry and powdered. 

Favus. — Favus is a contagious vegetable parasitic 
disease that attacks the scalp and very exceptionally 
the non-hairy parts of the skin. 

Furunculosis (Boils). — Furunculosis is an acute, 
localised inflammation occurring around the se 
baceous glands or hair follicles. The furunculi grow 
pyramidal in shape, and suppurate, the point of 
suppuration showing on the surface as a yellow spot. 

Herpes. — Herpes is characterised by one or more 
vesicular eruptions upon reddened bases. Fever 
blister and cold sore are symptoms. 

Lupus. — Lupus is a chronic tuberculous skin 
disease. 

Scabies (The Itch). — A contagious, animal para- 
sitic disease, due to the boring into the epidermis of 
a minute insect, the acarus scabiei. The penetration 
of this parasite leads to the formation of characteristic 
burrows and excites the development of a multiform 
eruption. The burrows are indicated by tortuous 
(rarely straight), thread-like lines of greyish, some- 
times whitish, colour which are occasionally mottled 
with black points. They vary in length from one- 
eighth to half an inch. The digital spaces, the inner 
side, and the soles of the feet are the most frequent 
locations of the infection. The eruption, which 
itches intensely, especial. y at night, consists of 
papules, pustules, and vesicles. 



A Synopsis of Important Diseases 459 

Trichpohytosis (Ringworm) . — a contagious disease 
of the skin due to the infection of the trichophyton 
fungus. It is characterised by the formation of circu- 
lar scaly patches, and if it occurs on the head, partial 
loss of hair. 

Urticaria. — Hives, characterised by the wheel-like 
appearance of the eruption, most frequently caused 
by indigestion, constipation, or the eating of certain 
foods. 

Diseases of the Ear 

The Auricle. — The principal diseases of the auricle 
are: 

i. Angiomata — growths consisting of blood-ves- 
sels. 

2. Epithelioma — cancerous growth. 

3. Othoematoma — an effusion of blood between 
the cartilage and the perichondrium, due to trauma 
and so frequently associated with insanity that it 
is known as the "insane ear." 

4. Wens — not infrequently seen in or about the 
lobe of the ear. 

5. Fibroma — of the keloid type usually due to 
piercing the lobe for ear-rings. 

The External Meatus. — The principal diseases 
of the external meatus are: 

1. Atresia — a narrowing of the external meatus. 
This may be due to malformation of the auricle, 
disease, or injury. Unless complete, it is not a direct 
cause of deafness. 

2. Eczema — an inflammatory condition attended 
with desquamation. 

3. Otitis external circumscripta or furunculosis — 
furuncles or abscesses in the external meatus. The 



460 Practical Nursing 

condition may last for weeks, or months, the sub- 
sidence of one furuncle being followed by the ap 
pearance of another. There may be considerable 
pain and, sometimes, temporary deafness, and rise 
of temperature. 

4. Otitis externa diffusa — diffuse inflammation of 
the meatus. This may be due to diphtheria, erysipelas, 
syphilis, or other infection and to parasitic mould. 

5. Otomycosis — the presence of parasitic moulds 
in the meatus. 

6. Tumours. — The exostoses, or bony tumours, are 
the most common. Granulomata may protrude 
from the middle ear. 

7. Wax impaction (ear wax). — This is usually due 
to a dirty occupation or to excessive interference with 
the meatus. If wax becomes impacted in the audi- 
tory canal, deafness, tinnitus, and a feeling of tension 
in the head ensue. 

The Tympanic Membrane. — The principal disease 
of the tympanic membrane is myringitis traumatica 
or infecta. This is acute inflammation of the drum 
membrane due to irritation. The hearing is generally 
slightly impaired. 

The Middle Ear. — The principal diseases of the 
middle ear are : 

1. Acute otitis media — an acute inflammation of 
the middle ear, which results in temporary deafness, 
pain, and more or less fever, ioi°-io3° F. This is 
a frequent complication of the infectious diseases, 
and of all forms of nasal catarrh. Lack of the care 
of the mouth in illness, and improper syringing of the 
nose are two very common causes of the trouble. 
The infection travels through the Eustachian tubes 
or is carried by the blood. 



A Synopsis of Important Diseases 4 61 

Proper treatment is imperative, as spread of the 
infection ma}' take place which may result in vertigo, 
tinnitus, permanent deafness, mastoiditis, epidural 
abscess, jugular thrombosis, meningitis, brain ab- 
scess and death. 

2. Chronic suppurative and non-suppurative 
inflammation. Both these forms, of which there are 
many varieties, may follow acute otitis media; or they 
may be the result of adenoids or other abnormal nasal 
conditions, or of infectious diseases. The amount 
of the subsequent deafness depends on the ex- 
tent of the inflammation and the presence or non- 
presence of complications. Attacks of pain, in chronic 
suppurative inflammation, are a serious symptom. To 
avoid increasing the condition, it is of the utmost 
importance that any nasal or pharyngeal disease 
which may exist be treated, and that anything likely 
to cause irritation in the ears be avoided. The main- 
tenance of good general health is also exceedingly 
necessary. 

3. Granulations and polypi. These are frequent 
complications of chronic suppurative inflammation. 

4. Necrosis and caries of the temporal bone and 
ossicles. This is usually the result of acute or chronic 
suppurative inflammation of the middle ear. 

5. Otalgia — a neuralgia of the middle ear. It is 
frequently caused by caries of the teeth ; less often, 
by throat and nose affections. 

Chronic non-suppurative inflammation of the 
middle ear is the most common cause of deafness. 
It is usually due to chronic affection of the naso- 
pharynx and sometimes to lowered general vitality. 
Attention should be gi\ T en to it at once, for, if it 
becomes long standing the tissue-change results are 



462 Practical Nursing 

most difficult to benefit. The symptoms are variable, 
progressive deafness, tinnitus, sense of weight, and 
fulness of the ear. 

The Auditory Nerve and Labyrinth. — Chronic 
non-suppurative inflammation of the middle ear is 
a common cause of gradual progressive disease of the 
labyrinth. There is tinnitus, loss of bone conduc- 
tion, deafness, and often, vertigo. This condition 
may be caused temporarily by drugs, such as quinine 
and the salicylates, and it sometimes follows typhoid 
and other infectious diseases. When the result of 
disease, the deafness is frequently permanent. 

Chronic meningitis may lead to deafness by causing 
destructive changes in the auditory nerve. Deafness 
from cerebro-spinal meningitis is generally the result 
of inflammatory changes either in the nucleus of the 
auditory nerve, its trunk, or in the labyrinth. 

Nursing. — For methods of irrigating the ear, see 
Chapter XII. When there is any discharge, care 
must be taken to clean the ear thoroughly. If a 
plug is used it should be of absorbent cotton and 
should be put in loosely, that it may not interfere 
with the drainage. It must be changed frequently. 

A large per cent, of deafness is due to neglect or to 
improper treatment. Nurses should discourage the 
use of unadvised remedies and recommend the con- 
sulting of an otologist (ear specialist) for all such 
aural defects as pain, tinnitus (ringing in the ear), 
discharge or deafness. 

Diseases of the Eye 

The Lids. — The principal diseases of the lids are: 

t. Blepharitis — a chronic inflammation of the 

margin of the lids. It is caused by uncleanliness, 



A Synopsis of Important Diseases 463 

the exanthemata, over-use or strain of the eyes, and 
exposure to irritating conditions such, as, dust, wind, 
or smoke. 

2. Chalazion — an enlargement of one of the 
Meibomian 1 glands due to stoppage of its duct. 

3. Ectropion — an eversion of the lid. 

4. Entropion — a rolling in of the margin of the lid. 

5. Hordeolum — or stye — an acute inflammation 
which occurs around the follicle of an eyelash. 

6. Ptosis — a dropping of the upper lid. 

7. Trichiasis — an inversion of the eyelashes which 
causes them to rub against the cornea. 

8. Tumours. The most common benign tumours 
which attack the lids are: (a) the milium — a yellowish 
tumour about the size of a pin's head, due to retention 
in a sebaceous gland; (b) the molluscum — a white 
tumour about the size and shape of a small pea; 
(c) xanthelasma, a small elevation beneath the skin, 
due to degeneration of the muscle fibre. 

Carcinoma is the most common form of malignant 
tumour. 

Epithelioma is a common tumour of the eyelids in 
old people. 

The Lachrymal Gland 2 and Ducts. — The prin- 
cipal diseases of the lachrymal glands and ducts are: 

1. Acute Dacryocystitis — an abscess of the lach- 
rymal sac. 3 

1 A row of small glands bordering the lids which secrete a 
thick liquid that prevents the tears from overflowing the 
lids. 

2 The lachrymal gland is the gland which secretes the tears. 
It is situated at the outer and upper part of the orbit. 

3 The lachrymal sac is a small sac near the nose which col- 
lects the excess moisture discharged from the duct. 



464 Practical Nursing 

2. Chronic Dacryocystitis — a chronic inflammation 
of the lachrymal sac, due to some obstruction in the 
nasal duct. 

3. Epiphora (" Watery Eye"). — This may be due 
to any affection or irritation of the lachrymal ducts 
or glands. 

The Orbit. 1 — The principal diseases of the orbit 
are: 

1. Cellulitis — a suppurative inflammation of the 
cellular tissue of the orbit. 

2 . Exophthalmos — a protrusion of the eyeball from 
the orbit. 

3. Periostitis — an inflammation of the orbital 
periosteum. 

The Conjunctiva. 2 — The principal diseases of the 
conjunctiva are : 

1 . Acute Catarrhal Conjunctivitis — an acute catar- 
rhal inflammation of the conjunctiva, accompanied by 
a muco-purulent discharge. 

2. Chronic Catarrhal Conjunctivitis. — A chronic 
inflammation of the conjunctiva. The discharge is 
less in quantity and not of as purulent a nature as in 
the acute form. 

3. Croupous Conjunctivitis. — This is characterised 
by the formation of a membrane on the surface of 
the conjunctiva. There is no infiltration into the 
tissues as in the diphtheritic form. The condition 
is generally due to irritants, chemical, mechanical, or 
thermic. 

4. Diphtheritic conjunctivitis — an acute inflam- 

1 The orbit is the bony cavity in which the eyeball is situated. 

2 The conjunctiva is the membrane lining the eyelids and 
covering the front of the eyeball up to the margin of the 
eyelids. 



A Synopsis of Important Diseases 4 6 5 

mation of the conjunctiva associated with exudation, 
infiltration, and a purulent discharge containing 
Loeffler bacillus. 

5. Follicular conjunctivitis — conjunctivitis asso- 
ciated with "follicles" upon the lower lid. 

6. Gonorrhceal ophthalmia — purulent conjuncti- 
vitis, due to gonorrhceal infection. 

7. Ophthalmia neonatorum — a gonorrhceal con- 
junctivitis occurring in the newborn. A very large 
per cent, of blindness is due to this cause. 

8. Pinguecula — a thickening of the connective 
tissue of the conjunctiva at the inner and outer sides 
or the cornea. 

9. Pterygium — a triangular-shaped vascular prom- 
inence of the conjunctiva with its apex extending on 
to the cornea. 

10. Trachoma (or granular lids) — a form of con- 
junctivitis accompanied with hypertrophy of the 
conjunctiva and the formation of "granules" and 
subsequent cicatrices. The secretion is contagious. 

The Cornea. 1 — The principal diseases of the cornea 
are: 

1. Keratitis — an inflammation of the cornea, 
which may be either suppurative, or non-suppurative. 

2. Keratoconus — a non-inflammatory conical pro- 
trusion of the centre of the cornea. 

3. Staphyloma — protrusion of the cornea, corneal 
tissue, and iris, accompanied by inflammation. 

The Sclera. 2 — The principal diseases of the sclera 
are: 



1 The cornea is a transparent membrane in front oc the iris. 
2 The sclera is a dense, white fibrous membrane which, to- 
gether with the cornea, forms the outer tunic of the eyeball. 
30 



466 Practical Nursing 

i. Episcleritis — an inflammation of the sub- 
conjunctival connective tissue. 

2. Scleritis — an inflammation of the sclera. 

3. Staphyloma — a thinning and bulging of the 
sclera. 

The Iris. 1 — The principal disease of the iris is 
iritis — an inflammation of the iris. 

The Uveal Tract. 2 — The principal diseases of 
the uveal tract are : 

1. Panophthalmitis — a purulent inflammation of 
the entire uveal tract. The eyeball is filled with pus 
and its functions are completely destroyed. 

2. Uveitis — inflammation of the uveal tract. 

Glaucoma. — Glaucoma is a disease of the eye char- 
acterised by increased intraocular tension. There 
are three varieties: acute inflammatory, chronic, and 
simple. In the first, there are repeated attacks of 
inflammation accompanied by severe pain and in- 
creasing diminution of vision. The second variety 
resembles the first, but the attacks are less severe and 
more gradual in their onset. In the third class an 
absence of all extreme symptoms is often observed, 
but there is a gradual increase of intraocular tension 
resulting in loss of sight. 

The Lens. 3 — The principal disease of the lens is 
cataract — an opacity of the crystalline lens or its 
capsule. Cataracts are known as: 

a. Partial when only part of the lens is involved. 

b. Complete, when the whole lens is affected. 

1 The iris is the curtain hanging in front of the lens in the 
centre of which is a small hole called the pupil. 

2 The uveal tract is made up of the choroid, the iris, and the 
ciliary body. 

3 The lens is a transparent body in the centre of the eye 
which directs the focusing of rays of light on the retina. 



A Synopsis of Important Diseases 467 

c. Stationary, when it does not spread. 

d. Progressive, when it gradually increases in size. 
Cataracts may be due to: 
i. Faulty development — congenital. 

Old age — senile. 

General disease. 

Ocular disease. 

Traumatism. 

The Retina. 1 — The principal disease of the 
retina is retinitis — inflammation of the retina. There 
are several varieties: 

(a) Simple retinitis, a simple serous inflammation 
of the superficial layer of the retina. 

(b) Albuminuric retinitis, which occurs in connection 
with nephritis. 

(c) Diabetic retinitis, which occurs in connection 
with diabetes. 

(d) Syphilitic retinitis, which occurs in connection 
with syphilis. 

(e) Hemorrhagic retinitis, in which there is 
haemorrhage into the retina. This is generally asso- 
ciated with disease of the heart or blood-vessels. 

(/) Purulent retinitis, which is due to the lodgment 
of septic emboli in the retinal arteries. 

The Optic Nerve. — The principal diseases of the 
optic nerve are : 

i. Hyperemia — congestion of the optic disc. 
This is most commonly the result of eye-strain from 
hypermetropia, and astigmatism, over-use of the 
eyes or working with insufficient, or too strong a light. 



1 The retina is a transparent membrane which lines the 
choroid and contains the nerve endings that receive the im- 
pressions of light and colour. 



468 Practical Nursing 

2. Optic neuritis — inflammation of the optic 
nerve. There are two varieties: 

i. Papillitic, in which the head of the nerve is 
affected. 

2. Retrobulbar, which affects the nerve fibres be- 
hind the eyeball. 

Disturbances of the Motility of the Eye. 1 — 
The principal disturbances of the motility of the eye are : 

i. Diplopia — a failure of the visual lines of the 
two eyes to direct toward the same object. 

2. Heterophoria — a slight tending of the visual 
lines away from parallelism, which can generally be 
corrected by muscular effort. 

3. Strabismus (squint) — is an advanced hetero- 
phoria which the patient cannot overcome. 

4. Paralysis — a loss of motion of one or more of 
the ocular muscles. 

5. Paresis — a partial paralysis. 

Nursing in Diseases of the Eye. — There is no 
other organ of the body in which disease will more 
quickly destroy its function. It is therefore im- 
perative, especially in all suppurative processes, and 
more particularly in those 'due to gonorrhceal infection, 
that treatment be started immediately. In such 
cases a delay of even a few hours may mean the 
loss of sight. The eye must be carefully irrigated, as 
already described in Chapter XV. In cases where 
there is much pus it may be necessary to do this as 
often as every twenty or thirty minutes; if pus is 
allowed to remain long in contact with the eyeball 
ulceration of the cornea may result. In cleansing 
the eye great care must be taken not to abrade the 

1 When objects are focussed correctly on the mocula of the 
eye, the vision is said to be binocular. 



A Synopsis of Important Diseases 4 6 9 

cornea; use a soft pledget of absorbent cotton (never 
gauze) wet in a mild antiseptic solution, and remove 
very gently all discharge that is not washed out by 
the irrigation. Never wipe toward the inner angle of 
the eye or the discharge may be washed into the 
lachyrmal sac and a serious inflammation result. 
When the lids are so swollen that the eye cannot be 
properly cleansed, the surgeon generally performs a 
canthotomy (cutting the outer angle of the eye). 
This not only allows of the eye being more readily 
cleansed, but also relieves the pressure on the eyeball. 
With proper care the resulting wound should heal in 
a few days. 

The method of putting medicine in the eye is 
described in Chapter XV. Applications are generally 
best made to the lids with an applicator made by 
wrapping absorbent cotton around a thin wooden 
stick. The cotton is moistened in the prescribed solu- 
tion, the lids everted (as described in Chapter XV.), 
and the moistened swab rubbed over their inner 
surface. Nitrate of silver, argyrol, and protargol are 
the germicides most frequently used in acute con- 
tagious diseases of the eye. Boric acid 2% is the 
antiseptic solution most frequently used for irrigation ; 
when bichloridp of mercury is used, it must not be 
stronger than 1 15000 as a stronger solution would be 
very irritating to the eye. 

Either hot or cold compresses are frequently ordered, 
especially in the early stages of inflammation. The 
latter should, however, never be applied without a 
doctor's order: heat encourages suppuration; there 
are therefore many instances in which it is injurious. 
Cold depresses the circulation, so its use must not be 
too long continued, and under certain conditions, such 



47° Practical Nursing 

as ulceration of the cornea, its use is contra-indicated. 

As has been already stated in Chapter X., the com- 
presses must be of light material, absorbent cotton 
being about the best. When there is suppuration, 
the same compress must never be used twice, and 
when both eyes are affected, separate compresses 
should be used for each eye. The compresses should 
be changed at least every two minutes, and cold ones 
kept on the ice till required. 

When only one eye is affected or when the inflam- 
mation is more virulent in one eye than the other, 
the well eye is sealed by covering with a "Buller's 
shield/' This consists of an ordinary watch crystal 
i^ inches in diameter, and two pieces of adhesive 
plaster, one 2 h and the other 2 inches square, with a 
hole one inch square- in the centre of each. The 
smaller piece of plaster is stuck to the concave side 
of the crystal, and the larger to its convex surface; 
being larger this extends beyond the other piece, and 
when the glass is placed — concave side down — over 
the eye, it is fastened to the face above and below 
the eye and on the nose ; it is left free on the temporal 
side to give ventilation. 

As it would not be safe to put glass over the eye of 
a small child or a very restless patient, a gauze pad 
held in place with a bandage is used in such cases. 
The bandage should be removed twice a day and the 
eye well washed; a 2% solution of boric acid is gen- 
erally used for this purpose. When the patient is a 
child it is often well to secure its arms before treat- 
ment by wrapping it in a sheet. 

All dressing used in contagious diseases of the eye 
should be burnt immediately after removal; they 
should be handled as little as possible, and the danger 



A Synopsis of Important Diseases 47 1 

of infecting one's own eyes constantly remembered 
and guarded against. 

The patient's room should be uncarpeted and the 
floor mopped daily but never swept; in the majority 
of cases the room is kept at least moderately dark. 

The patient's general health must receive attention ; 
a light nutritious diet is required, and the bowels 
should be kept freely open. 



CHAPTER XXIV 

FOOD 

The Nature of Food. Digestion. Infant Feeding. Modifica- 
tion of Milk. Cooking. Serving. Diet in Disease. 

THE food we eat being the chief factor in main- 
taining life, improper food, being a predis- 
posing cause of disease, and diet being nowadays 
more and more considered in the treatment of disease, 
it is very important that nurses should have some 
knowledge of the chemical constituents of food, of the 
action of the different food materials on the body, and 
of the food suitable to be given under certain con- 
ditions and in disease. In a book of this kind it 
would be impossible to go very thoroughly into the 
subject but the following synopsis contains a col- 
lection of notes which it is particularly important 
to remember. 

The principal primary elements of food are oxygen, 
carbon, hydrogen, nitrogen, sulphur, phosphorus, 
potassium, sodium, calcium, magnesium, and iron. 
Food is divided into classes, nitrogenous and non- 
nitrogenous, according to the amount and combina- 
tion of these elements. The first class comprises 
all proteid food; the second, carbohydrates, fats, 
minerals, and water. 

The chief uses of food are: (a) to form the body 
tissues; (b) to repair their waste; (c) to yield heat, 

472 



Food 473 

for the purpose of keeping the body warm and gener- 
ating energy for the work it has to accomplish. 

The heat and energy are developed as the food»is 
digested and absorbed in the body. The calorie is 
the unit used in estimating the amount of heat thus 
generated. One calorie represents the amount of heat 
required to raise the temperature of a pound of water 
4°F. 

Each class of food generates a different degree of 
heat, thus: 

lib. of proteid contains . . . 1.820 calories 

1 " " fat contains 4.040 

1 " " carbohydrates contains . 1.820 

The amount of each variety of foodstuff required 
to keep the body in health varies under certain con- 
ditions, such as sex, age, mode of life, and climate. 

Atwater gives the following standard for a man 
doing hard labour : 

Proteid Fat Carbohydrates Calories 

150 grms. 150 grms. 500 grms. 4060 

and for a man doing moderate work: 

Proteid Fat Carbohydrates Calories 

125 grms. 125 grms. 450 grms. 3520 

A woman requires four- fifths of a man's rations. 
A child between the ages of 14 and 16 requires nine- 
tenths of the adult ration, and one-tenth should be 
subtracted for each two years less of life. 

More fat is required in cold countries, and less in 
tropical, carbohydrate food replacing the fat. 

Nitrogenous Foods 

Nitrogenous foods are the tissue builders. They 
make the flesh of the body, they improve the con- 
dition of the muscles; they build up and repair the 



474 Practical Nursing 

albuminoids of the blood, milk, and other liquids; 
they also liberate a small amount of energy by 
oxidation. 

Nitrogenous foods consist principally of nitrogen, 
carbon, oxygen, hydrogen, and sulphur. Under this 
head are classed: all parts of animal food, except fats 
and glycogen ; milk, eggs, and the nitrogenous constitu- 
ents of vegetables and cereals. The principal nitroge- 
nous or proteid substances of meat are : myosin, which 
is the basis of muscle; fibrin, found both in the muscles 
and blood; and albumin, found in the blood and 
juices. The nitrogenous constituents of fish are 
chiefly gelatine and albumin. The proteids of 
milk are lact- albumin and casein; of the yolk of egg, 
vitellin; of the white of egg, albumen; of vegetables, 
legumin; and of cereals, gluten. 

Meat. — The value of meat varies greatly with the 
part of the animal from which it is taken. The parts 
which have done the most work in life, e.g. the neck 
and legs, are the toughest, but at the same time the 
most juicy. Hence they are used for soups and 
broths. The parts which have done the least work, 
e.g. the upper portion of the hind quarter, are the 
most tender, but the least juicy. They make the 
best, roasts and steaks. The intermediary portions 
are used for stews and pot roasts. 

Meat from young animals is more tender but less 
nutritious than that from older ones. 

Veal, owing to a lack of salts, is lacking in flavour 
and is not as digestive as beef. When too young — 
under six weeks, — it is very indigestible. 

Mutton, being fatter than beef and this fat being 
largely stearin, is considered by some authorities 
less digestible than beef. 



Food 475 

Lamb contains a large per cent, of fat. Therefore 
something acid (such as pickles, mint sauce, etc.) 
is served with it to counteract the effect of the fat. 

Pork, owing to a large per cent, of fat, is the least 
digestible of all meats. 

Ham and bacon are much more easily digested 
than pork, especially bacon when it is sliced and 
cooked crisp. 

Fowl, chicken, and pigeon are very easily digested. 
Ducks and geese are less easily digested, owing to a 
larger per cent, of fat. 

Game is easily digested, but it is too highly seasoned 
for general invalid diet. 

Extractives or Meat Bases. — Extractives are 
so called because they are easily dissolved out or 
extracted from the meat. They consist largely of 
substances called creatin and creatinin, xanthin 
and hypoxanthin. Their action somewhat resembles 
that of thein and caffein, the active principles of tea 
and coffee. They have little nutritive value, but they 
are slightly stimulating and give meats their flavour. 

Gelatin. — Gelatin is easily oxidised. It is there- 
fore, under certain conditions, of value, as it serves 
to economise the albuminoids. Owing to its muci- 
laginous nature, it is useful in many disorders of the 
stomach; but, as it is almost entirely digested in the 
intestines, its use is counterindicated in disease of 
the same. It has very little nutrient value. 

Fish. — Fish contains less nutrient than meat, but 
is quicker and more easily digested. It is therefore 
particularly suitable for people whose digestive 
powers are impaired, and those of sedentary habits. 
Dark fish contains a larger per cent, of fat than white, 
and is therefore less easy of digestion. 



476 Practical Nursing 

Eggs. — Eggs contain all the food principles except 
carbohydrates. Owing to their containing a com- 
paratively large amount of iron, they are particularly 
valuable in cases of anaemia, and the presence of 
sulphur renders them unfit, in many instances, for 
persons of weak digestion, because, if absorption from 
the intestine is delayed, decomposition ensues, and 
sulphuretted hydrogen and ammonia are produced. 
This is particularly true of the yolk. The white can 
be used in many cases where the yolk might be pro- 
ductive of serious gastro- enteric disorder. 

The decomposition of eggs is due to the entrance of 
bacteria through their shells. They should be kept 
in a cool, clean place therefore, to prevent the entrance 
and development of bacteria. 

Milk. — Milk is the most easily digested form of 
proteid food. It contains all the ingredients necessary 
to maintain life. 

In diseases in which a large amount of nourishment 
is not required, sufficient can be obtained from milk 
alone ; but, owing to the excess of water in its compo- 
sition, it would have to be taken in too large quan- 
tities by those leading an active life. When milk 
is skimmed, the proportion of fat is, of course, greatly 
reduced, but the protein remains about the same. 
Casein is the most indigestible constituent of the 
milk. When curds are present in the stools, it shows 
that the casein is not being properly digested. It is 
then often removed by clotting milk with rennet and 
straining off the whey. The whey contains the lact- 
albumin and salts. At other times, lime water, 
barley water, or aerated waters are added to the milk. 
The first works by rendering the reaction of the milk 
so intensely alkaline that it is not easily curdled; the 



Food 477 

last two prevent this hard curdling by separating the 
particles of casein. 

Non-Nitrogenous Foods 

The non-nitrogenous foods are: Carbohydrates, 
fats, minerals, water. 

Carbohydrates. — Carbohydrates consist of carbon, 
hydrogen, and oxygen. They liberate heat and 
muscular strength, and, being easily oxydised, they 
save the tissue from consumption. 

There are three classes of carbohydrates: amyloses, 
glucoses, and sucroses. The amyloses include starch, 
dextrine, cellulose, gums, and glycogen; the glucoses, 
dextrose and levulose ; the sucroses, cane sugar, lactose, 
and maltose. 

Food plants are classed under four heads: (i) 
cereals, of which the seeds are used — rice, wheat, rye, 
and barley; (2) legumins, or pod plants — peas, beans, 
and lentils; (3) roots and tubers — potatoes, arrow- 
root, sago, etc. ; (4) green vegetables — lettuce, spinach, 
etc. 

The legumins contain the most protein of any of 
the vegetables. They also contain a fair amount of 
starch and are richer in salt than cereals, but a large 
proportion of cellulose renders them indigestible, and 
as they contain sulphur their use in excess will 
cause flatulence. 

Roots and tubers are chiefly valuable for their 
starch and salts. They also contain sugar, pectine 
(or vegetable jelly), and vegetable acids. 

Green vegetables hold very little nutrient, but are 
valuable for their salts. 

The value of fruit as a food lies in its sugar, free 
acids, and salts. 



47^ Practical Nursing 

Nuts contain a large per cent, of fats. This and a 
large amount of cellulose render them hard to digest. 

Sugar. — The use of sugar must be limited, for it 
is very rapidly absorbed, and an excess causes an 
overloading of the system that may result in indi- 
gestion or derangement of the excretory organs. 
Cane sugar, especially, delays digestion and is irri- 
tating to the mucous membrane. Used in small 
quantities, however, sugar may take the place, 
weight for weight, of starch, as a generator of heat 
and muscular force; and as it is more quickly digested, 
it is to be preferred during unusually hard work. 
Its action is, however, more effervescent. Sugar is 
very valuable in tropical dietaries, where fat cannot 
be taken in any quantity. 

Sugar is changed by the gastric juice into glucose 
and lactic acid. In disease, when the absorptive 
power of the stomach is diminished, sugar should 
only be taken in very limited quantities, since it is 
liable, if not quickly absorbed, to ferment in the 
intestines. 

Fat. — Fat is the chief fuel ingredient of food, a 
pound of fat being more than the equivalent of two 
pounds of proteid or carbohydrate. It forms fatty 
tissue, but not muscular. The amount of fat required 
in the diet depends upon the amount of heat and 
energy required. Thus people in cold countries 
and those who do hard labour will digest and assimilate 
a larger amount of fat than people living in warm 
climates or those doing work that does not require 
the output of a large amount of energy. 

Minerals. — When food is burnt, a varying amount 
of ash is left behind; this is the mineral matter or 
salts. These salts are very necessary for the well- 



Food 479 

being of the body, since salts enter largely into the 
composition of all muscular and osseous tissue and 
are a very important constituent of the blood and 
other liquids. A lack of lime salts may result in 
rickets and malformation of the bones. A lack of 
iron may impoverish the colouring matter of the red 
blood corpuscles on which depends their power of 
carrying oxygen to the tissues, and this impoverish- 
ment may cause anaemia or other disorder of deficient 
oxydation. A lack of potash salts predisposes to 
scurvy, and a diminished supply of sodium chloride 
interferes with the process of digestion by changing 
the reaction and density of the gastric secretions. 

These salts leave the body in large quantities in 
the excreta, and this daily loss must be made good by 
the food. When a deficiency of any one salt is 
obvious, food containing a large amount of the same 
should be given. Thus rare beef should be furnished 
in anaemia, because beef contains a larger amount of 
iron than any other foodstuff; potatoes in scurvy, 
because potatoes are rich in salts of potash; and 
similarly green vegetables and fruit are beneficial in 
the majority of blood diseases. The phosphates, 
which are chiefly needed for the solids of the body, 
are obtained from vegetable food, and the sodas and 
chlorides, which are principally required for the 
liquids of the body, from animal food. 

Water. — A certain amount of water is necessary 
to proper digestion and metabolism. It acts as a 
solvent for food and accelerates tissue change. People 
who do not drink sufficient water are liable to have 
an accumulation of waste products continually in 
the system. The amount of water taken under 
ordinary circumstances, counting that of both solid 



480 Practical Nursing 

and liquid food, averages about four pints daily, while 
the average amount removed from the body by the 
kidneys, bowels, skin, and lungs, averages about 
four and one-half pints. The excess is formed within 
the system during the process of oxydation. 

Spices and Condiments 

Spices and condiments are very necessary food 
adjuncts. They stimulate, by their action on the 
mucous membrane of the stomach and on the organs 
of taste and smell, the secretion of gastric juice, and 
by improving the flavour, increase the appetite. Ex- 
cessive use of condiments causes indigestion by over- 
irritation and stimulation of the secretory organs 
of the stomach. 

The addition of sodium chloride is of particular 
importance, as it is from it that the stomach manu- 
factures hydrochloric acid. 

Flavouring extracts are volatile oils. They must 
therefore be kept tightly corked and, when possible, 
be added only at the completion of cooking. 

Beverages 

Cocoa axd Chocolate. — Cocoa and chocolate, 
unlike coffee and tea, have a decided food value. 
Though stimulants, owing to the presence of theo- 
bromine, they are less apt to induce nervous symptoms 
than tea and coffee; but a large proportion of fat 
(cocoa contains about 28%, chocolate, 48-50%) 
renders them unsuitable for people with weak di- 
gestions. They are both made from the seeds of the 
cacao fruit. Chocolate is prepared by adding starch, 
sugar, and a flavouring extract to cocoa. 



Food 481 

Coffee. — Coffee has a stimulant effect upon the 
system owing to the presence of caffein. Like tea, 
it contains tannin, though in a smaller quantity. 
If allowed to stand too long on the grounds, or if 
taken in excess, it will cause indigestion, and, in some 
people, insomnia and nervousness; otherwise, when 
properly made and taken in moderation, its action is 
rather beneficial. 

A combination of one part Mocha to four of Java 
is about the most popular combination. 

Tea. — Tea is made from a plant which grows chiefly 
in China, Japan, and India. There are two classes, 
black and green. There are many varieties of both 
black and green tea, all of which are obtained from 
the same plant, the finer and better teas being made 
from the small leaves and the coarser teas from the 
large ones. Black teas are fermented before drying, 
and green teas are not. As fermentation makes 
tannin less soluble, an infusion of black tea will con- 
tain less tannin than one of green. 

Tea, owing to its active principle theine, is stimu- 
lating and refreshing, and by reason of the astringent 
action of the tannin on the tissues of the digestive 
organs it retards waste and digestion. It is there- 
fore, when properly made, good for old people and 
for persons doing hard work, but it is bad for young 
children and for persons with weak digestion or 
nerves. As it retards digestion, tea should not be 
taken with, or soon after, a heavy meal. 

The Digestion of Food 

All food must undergo certain changes before it 
is ready for assimilation. This preparation is known 
as digestion ; and digestion together with the assimila- 
31 



482 



Practical Nursing 



tion of the digested food, the consequent formation 
of new tissue, and the breaking down of old tissue 
is known as metabolism. 

There are two processes of digestion, mechanical 
and chemical. The former consists of mastication, 
swallowing, the churning motion of the stomach, 
and the peristaltic action of the intestine. 

Chemical digestion is due to the enzymes or fer- 
ments contained in the digestive juices of the body. 
The action of these ferments on the different food- 
stuffs is shown in the following table: 

Fluid. Ferment. Action. 

Saliva Ptyalin Turns starch to sugar. 



Gastric juice Rennet Solidifies fluid proteid. 

Turns proteids into pep- 
tones. 
Inverts cane sugar. 

Like ptyalin. 

Like pepsin in an alkaline 
medium; it transforms 
the peptones into leucin 
and trypsin. 

Decomposes fats. 

Inverts sucroses. 

Like pepsin and tyrosin. 

Bile Diastatic Like ptyalin. Bile also 

emulsifies fats, acts as a 
disinfectant, and lubri- 
cates the intestinal walls. 

The reaction of the saliva and pancreatic juice is 
alkaline; that of the gastric juice, acid. This acidity 
is due to the presence of hydrochloric acid, which is 
manufactured by the stomach from the sodium chloride 
eaten with the food. 



Rennet 
Pepsin 

Invertine 



Pancreatic juice Amylopsin 
Trypsin 



Ptyalin or 
Steapsin 

Intestinal juice Invertine 

Proteolytic 



Food 483 

Babies under eight months have very little ptyalin 
in their saliva; therefore starch must never be given 
them unless fully dextrinised. 

To test for starch. Pour a little tincture of iodine 
on the substance to be tested; if the tincture turns 
blue, starch is present. 

The absorption of food takes place mainly in the 
small intestines. The nutritive value of food is 
estimated by its degree of absorbability. The fol- 
lowing table, taken from Bulletin No. 142 U. S. Dept. 
Agriculture, shows the average degree of the absorba- 
bility of the different foodstuffs. 





Protein. 


Fat. 


Carbohydrates 


Meat and fish 


97% 


95% 


98% 


Eggs 


97% 


95% 


98% 


Dairy products 


97% 


95% 


98% 


Mixed diet: 








Animal food 


97% 


95% 


98% 


Cereals 


85% 


9°% 


98% 


Legumes (dried) 


78% 


90% 


97% 


Sugar 






98% 


Starches 






98% 


Vegetables 


83% 


9°% 


95% 


Vegetable foods in 








mixed diet 


84% 


9°% 


95% 


Fruits 


85% 


9°% 


9°% 


Total food of mixed 








diet 


92% 


95% 


97% 



When the functions of the digestive organs are 
impaired, it is often necessary to predigest the food 
before it is eaten — i.e., to cause changes in it similar 
to those caused by the digestive ferments. These 
changes are obtained by heat and by chemically 
prepared ferments which have the same action as 
those of the digestive juice. Thus the casein of milk 
is coagulated by the action of rennet, a ferment ob- 



484 Practical Nursing 

tained from the stomach of calves; milk is peptonised 
by the use of pancreatin; cereals are dextrinised by 
the use of long-continued heat, by ferment, etc. 

In using ferments, it is imperative to follow im- 
plicitly the directions given for their use. They will 
only act at certain temperatures; and if their action 
is not arrested at the right time (by raising the tem- 
perature of the food or by putting it on ice) , the food 
will become too fully digested and so be rendered 
bitter. 

It has been found by scientific research, that the 
various ferments of the body are not supplied in an 
unlimited degree. Therefore, if the body is to be 
properly nourished and all the food which is eaten 
is to be utilised, the proportions of the constituents — 
i.e., the protein, fat, and carbohydrates — must be 
properly balanced, (see page 473). 

Bulletin No. 28 of the U. S. Dept. of Agriculture 
(which can be obtained by application to the Secretary 
of the U.S. Dept. of Agriculture) gives the relative 
per cent, of the protein, fats, carbohydrates and 
minerals in different foods, and the food value of 
the more important foodstuffs. There are also 
several charts and dietary computers on the market 
which give these quantities in grammes. With the 
aid of these, it is an easy matter to make out properly 
balanced menus. 

Rules Governing the Cooking of Food 

Many of the nutrient and digestible qualities of 
food are lost by improper cooking. In illness, both 
its digestion and absorption are liable to be retarded 
and imperfect. It is therefore very important, 
first, to avoid all possible loss of the nutrient con- 



Food 485 

stituents of any food, that the required amount of 
nourishment may be given in little bulk ; and, secondly, 
to do everything to render it as nearly as possible 
ready for assimilation, that the digestive organs may 
be spared all unnecessary labour. 

Facts Regarding the Action of Heat, etc. — 
To fulfil these requirements, it is necessary to re- 
member the following facts regarding the action of 
heat, acids, alkalies, etc. on the more common food- 
stuffs. 

1. Albumen. Albumen is coagulated by heat 
(i5o°-i7o° F.), alcohol, and mineral acids. It is 
soluble in vegetable acids and cold water. 

2. Casein. Casein is coagulated by all acids, by 
rennet, and, to a slight extent, by heat. 

3. Legumin. Legumin is coagulated and har- 
dened by salt. 

4. Starch. Starch is dextrinised by heat and 
by certain ferments. It is soluble in water. 

5. Sugar is inverted into glucose by heat and 
acids. Glucose is only half as sweet as sugar. 

Practical Application of Facts Regarding the 
Action of Heat, etc — 1. Albumen and albumi- 
noids of a like nature are coagulated by heat, alcohol, 
and mineral acids. Albumen is soluble in cold water. 

(a) Milk. If milk is heated above 150° F., the 
lact-albumin (the most easily digested proteid sub- 
stance of the milk) coagulates and forms in an in- 
digestible scum on top of the milk. Much of the 
natural salts of the milk is collected in the forming 
scum and is thus also lost. It is the loss of these salts 
that renders sterilised and improperly Pasteurised 
milk objectionable for infant feeding, (b) Eggs. 
Egg albumen coagulates at a temperature of i7o°F. 



486 Practical Nursing 

If the heat exceeds this to any great extent, the al- 
bumen is hardened and so rendered indigestible. 
Therefore, cook eggs slowly, do not boil them, (c) If 
meat is exposed to a high degree of heat for a few 
minutes, the albumin will coagulate and form a crust 
which will keep in the extractives, but, if the high 
degree of heat is maintained too long, the albumin 
will be hardened and the meat rendered tough. 
Therefore in boiling or roasting meat, expose it to a 
high degree of heat for a few minutes — eight to ten — 
to prevent the loss of extractives and consequent loss 
of flavour, and then lower the temperature to prevent 
the meat from becoming tough. In making stews 
or soups, never allow the heat to exceed i8o°F., or 
the coagulation of the albumin will prevent the 
escape of the juice which is wanted in the soup and 
gravy of the stew, (d) Put cereals and vegetables 
into boiling salted water, while it boils, that the pro- 
teid may be coagulated and that consequent loss of 
it and of the salts may be prevented. As a further 
preventive, it is better to cook potatoes before 
peeling them, (e) Be careful when adding alcohol 
and mineral acids to eggs and milk or they will 
curdle. (/) Never let meat stand in water unless you 
wish to draw out the extractives, as in soups and stews. 
To wash meat, rub with a damp towel. 

2. Casein is coagulated by acids and rennet. 

Casein of milk is not always easily digested. The 
casein can be coagulated by the addition of acids 
or rennet, preferably the latter, and the whey strained 
from it. The whey contains the lact-albumin, salts, 
and water. It is necessary to remove the fat by 
skimming before putting in the rennet, as it interferes 
with the curdling of the casein. 



Food 487 

3. Legumin is coagulated by salt. 

When cooking peas, beans, and lentils, do not put 
salt into the water until they are soft. If the water 
is hard, neutralise by adding bichloride of soda. 

4. Starch is dextrinised by heat and by ferments. 
It is soluble in water. 

(a) Do not cook potatoes, which are rich in starch, 
too long or they will be waxy, owing to the conversion 
of the starch to dextrine. (6) Cereals should be 
partially dextrinised before being eaten. Therefore 
they should be cooked for a long time, especially for 
children, or the cooking should be replaced by the 
addition of some dextrinising ferment, such as diastase 
of malt, (c) Do not soak new vegetables in water, 
or there will be a loss of starch and salts. Old 
vegetables, having lost their water, will not lose their 
starch until a certain amount of water has been 
absorbed, and they are improved by soaking for from 
one to one and a half hours. 

5. Sugar is inverted into glucose by heat. Glu- 
cose is only half as sweet as sugar. 

As glucose is only half as sweet as sugar, the sugar 
is wasted if it is added to mixtures until they have 
nearly finished cooking. Of course, in many in- 
stances — as in baked puddings — this cannot be helped, 
but when possible add sugar only shortly before 
removing the substances from the stove. 

Effect of Cooking. — 1. Meat. Its connective 
tissue is softened, its flavour is improved, and the meat 
is rendered more palatable by the coagulation of the 
blood, etc. Germs are killed, and the nutriment is 
rendered more concentrated by the loss of a certain 
per cent, of water. A certain amount of fat and ex- 
tractives are also lost, but a too great loss of the 



488 Practical Nursing 

latter will be prevented by proper cooking. 2. Vege- 
tables and cereals. The cellulose envelopes surround- 
ing the starch granules are softened and ruptured 
and the starch granules swell, forming, if properly 
cooked, a mealy paste. Cellulose in its natural state 
is too hard to be acted upon properly by the digestive 
organs of the body. 

Infant Feeding 

Modifications of Milk. — The two first considera- 
tions in the preparation of milk for infants are the 
capacity of the stomach and the nature of the milk. 
Capacity of the Stomach: 

Third to seventh day 1 -1 \ oz. 

Second to third week 1^-2 J " 

Fourth to fifth week 2^-3 " 

Sixth week to third month 3 -4^ " 

Third month to fifth month 4 -5^ " 

Fifth month to ninth month 5^-7 " 

Ninth month to twelfth month lh~9 " 

The smaller the amount of the feedings, the more 
frequently they must be given. Thus, from the 
third day to the end of the fifth week, they are given 
every two hours from 6 a.m. to 10 p.m., and every two 
and one-half hours during the night; from the sixth 
week to the third month, every two and a half hours 
during the day, but only once between 10 p.m. and 
6 a.m.; from the third to the ninth month, every 
three hours during the day, but not at all after 10 p.m. ; 
from the ninth to the twelfth month, every three and 
a half hours during the day, but not at all after 10 p.m. 
Nature of the Milk. — The milk given infants 
must not only contain the same constituents, but 
must have these constituents in the same proportions 



Food 



489 



as human milk. The difference between the per- 
centages of the constituents of human milk and 
cow's milk can be seen in the following table: 

Human Milk "Certified Cow's Milk" ■ 

Fat 4. 00% 4. 00% 

Sugar 7-°°% 4-3°% 

Protein 1 . 5 0% Protein 4 . 00% 

Salts .20% Salts . 70% 

Water 87.00% Water 84.00% 

Changing the proportions of the constituents of 
cow's milk to those of human milk, is called "modi- 
fying milk." 

Human milk undergoes a slow but continual change 
during the months of lactation. Therefore in modifying 
milk the child's age is taken into consideration, and a 
corresponding change is made in modified milk thus : 





Fat 


Sugar 




% 


% 


3-7 days 


2.0 


6.0 


1-4 weeks. 


2 


5 


6.0 


1-3 months. 


3 





6.0 


3-4 


3 


5 


6.0 


4-6 " 


4 





6.0 


6 -9 :; 


4 





7.0 


9-12 


3 





6.5 



Pro- 
tein 
% 



0.60 
0.70 
1. 00 
1-25 
i-5o 
2.00 
2.50 



To make, take 



Milk Lime 
Sugar Water 



Milk 



4 oz 
5 



Sterile 
water 

q. s. to 
make 



20 oz. 



1 Cow's milk varies considerably in the relative quantity of 
its constituents, especially in the proportion of fat. Certified 
milk, i. e., milk inspected according to law, calls for the above 
amount of fat and for not more than 40,000 non-pathogenic 
bacteria to the c. c. Certified milk should be used in the 
preparation of infant food. 

2 To obtain 10% milk, take the upper 10 oz. off the regular 
quart bottle in which the certified milk is sold. 

3 To obtain 7%, take the upper 16 oz. 

4 To obtain 4%, use the whole milk as it comes. (Mix cream 
and milk thoroughly.) It is, of course, the fat or top milk 
which is used for the prescriptions. 



49Q 



Practical Nursing 




The best way to remove the cream from the milk 
is to take off the first ounce with a teaspoon and the 
remainder with a Chapin milk dipper. These 
dippers are very inexpensive and can 
be bought at any drug store. 

The reaction of the cow's milk is 
alkaline when first drawn, but it very 
quickly becomes acid, while human milk 
does not. 

Lime water is used to counteract 
this acidity of the cow's milk. 

Barley water is often used instead 
of the sterile water; it not only gives 
additional nourishment, but, owing to 
its mucilaginous nature, it keeps the 
casein from coagulating in hard 
curds. It must be dextrinised fully, 
before being added to the milk. To 
dextrinise pearl barley, it is necessary to boil 
it at least two hours; and prepared barley, such 
as "Robinson's Patent Barley" which is fre- 
quently used, from thirty to forty minutes. Many 
doctors advocate the addition of a dextrinising 
ferment. 

The child's age is not always an accurate guide 
for its feeding. If the child loses in weight, vomits, 
has colic, or if its stools are in any way abnormal, 
the probabilities are that its food is not in right 
proportion. 

If the child loses or does not gain in weight, the 
probabilities are that it is not getting sufficient sugar. 
If it has colic, or green, acid, watery stools, that 
it is getting too much sugar. 

If there are frequent vomitings and diarrhoea, 



Chapin 

Milk 

Dipper 



Food 49 x 

with small lumps of fat in the stools, that it is getting 
too much fat. 

If it is troubled with constipation, that it is getting 
too little fat. 

Curds in the stools, colic, diarrhoea, and vomiting 
indicate too much protein. 

To Prepare the Milk: 

Dissolve the milk sugar in the lime water, add the 
milk slowly, then add the sterile, or barley, water. 

After mixing the milk, pour the quantity required 
for each feeding into a separate bottle, using a funnel. 
Plug the bottles with sterile non-absorbent cotton, 
and, unless the milk is Pasteurised, put them im- 
mediately in the ice-box. 

To Pasteurise the milk when no regular apparatus 
is to be had: Place the bottles (having one extra 
one) in a wire or other basket, and put this in a sauce- 
pan of cold water with a saucer or piece of wood under 
it. Bring the water to such a temperature that the 
milk in the bottles is raised to 150°. Keep the milk 
at that temperature for thirty minutes. Always put 
the thermometer in the same bottle and throw the 
milk in that away. 

Cool the milk rapidly 1 by putting the bottles in 
lukewarm running water and reducing the tempera- 
ture of this with ice, as quickly as possible without 
breaking the bottles. Keep it in the refrigerator. 
Warm the milk by putting the bottle in warm water 
to ioo° F., before giving it to the child. See that he 
gets it and takes it while it is warm. 

1 Pasteurising milk kills the germs but not the spores. If 
the milk remains warm for any length of time the latter will 
develop. The bottles should never be put immediately in the 
ice-chest, since the too sudden change of temperature changes 
the composition of the milk. 



49 2 Practical Nursing 

Pasteurised milk is not as frequently used as for- 
merly, especially where it is possible to get "in- 
spected milk." 

When the milk is not to be Pasteurised, it is a 
wise precaution to sterilise the milk bottles before 
filling them; and the necessity of having the room 
in which the milk is prepared, and everything used 
in its preparation (including the worker's hands), 
absolutely clean and free from dust is increased 
tenfold. 

After milk bottles have been used, rinse them 
immediately in cold water, and wash in soda or 
borax and hot water, using a bottle brush. Rinse 
the nipples in cold water, put them on the fingers, and 
scrub with soap and water. Then turn them inside 
out, and scrub the inside parts in like manner. The 
rest of the treatment of the nipples differs in different 
institutions. 

The following are the most common methods of 
procedure : 

i. Have an individual nipple for each child, and 
keep, between use, in a mug of boric acid. 

2. After use, boil each nipple for three minutes 
in salt solution. 

3. Have a sufficient number of nipples, to last 
twelve hours, dry them after washing, and keep them 
in a clean jar. Boil them all at the same time and 
either put them into a jar of boric acid, or dry 
them with sterile towel and keep in a dry, sterile, 
air-tight jar. 

To determine whether the hole in the nipple is the 
proper size, hold the bottle upside down. If the 
nipple is in good order, the milk flows through, drop 
by drop. If the hole is too small, make it larger 



Food 493 

by puncturing with a sewing needle which has been 
heated until the point is red. Never use a nipple 
in which the hole is too large. 

The Serving of Food 

Some of the chief points to be considered in the 
serving of meals are: 

i. To see that the dishes are clean, whole, in 
proper position on the tray, and that the latter is made 
to look as attractive as possible. A certain amount 
of appetite and excretion of the digestive juices are 
necessary for proper digestion and these can be 
excited, to some extent, by pleasant odours and by 
an attractive and appetising appearance in the food. 
On the other hand, badly served food will, by dis- 
gusting the patient, destroy his appetite, and inter- 
fere with the digestion of the meal. 

2. Never serve too large an amount of food at one 
time, especially when the patient's appetite is poor. 
Not only does the sight of too much food often take 
away the little appetite he may have, but food served 
in small quantities and often, will be digested better, 
when the functions of the digestive organs are im- 
paired than larger amounts taken at longer intervals. 

3. Serve everything intended to be hot, hot, and 
cold things, cold. The serving rooms of the majority 
of modern hospitals are now equipped with steam 
tables, so that there is (in such, at any rate) no excuse 
for cold meals being served. Nurses, however, 
occasionally forget to turn on the steam, leave the 
windows open while preparing their trays, put the 
hot food on the trays before the cold, or use cold 
dishes. Such blunders are unpardonable. The food 
is often taken to the patient while he is receiving 



494 Practical Nursing 

treatment and is not given him till the treatment is 
finished. He may also be obliged to wait for his food 
until a helpless patient who must he helped to eat 
has been given his. Miscalculations of this sort are 
likewise unpardonable. 

In feeding a patient, always fold a table napkin 
or towel under his chin. When giving liquids, raise 
his head slightly by slipping your arm under the 
pillow, but be careful not to throw his head forward 
on his chest, since this makes it difficult for him to 
swallow. Hollow glass tubes — drinking tubes — are 
superior, unless the patient is very weak, to the old- 
fashioned feeding cups for administering liquids. 
These tubes can easily be bent to any angle after 
they have been heated slightly. They should always 
be washed immediately after use. When a patient 
is delirious, it is often advisable to give him even his 
liquids with a teaspoon. 

Diet in Disease 

Anemia. — In anaemia and other blood disorders, 
the diet should be particularly easy of digestion and 
rich in salts. Milk, eggs, rare beef, sweet fruit, and 
articles of a like nature should therefore be liberally 
supplied. 

Cardiac Disease. — In cardiac disease, it is generally 
necessary (especially when there is oedema) to limit 
the liquids in the diet, an excess giving the heart 
extra work to do and providing more fluid to escape 
into the tissues. Fats and carbohydrates must also 
be limited, as, under the existing conditions, they 
have a tendency to produce flatulence. It is very 
essential that all food should have a high nutritious 
value. This is, of course, particularly imperative 



Food 495 

when it becomes necessary to put the patient on a 
liquid diet. Some physicians then order the milk 
fortified with such substances as albumin plasmon, 
milk sugar, and meat extract. 

Constipation. — In constipation, food likely to 
irritate and stimulate the intestinal tract should be 
given. Examples: oatmeal, wheaten grits, whole 
wheat bread, vegetables, and fruit. Plenty of water 
should be drunk. Fatty meats, pastry, eggs, and 
milk puddings should be avoided. 

Diabetes. — In diabetes, owing to the incapacity 
of the system to assimilate sugar, all sugar and starch, 
as far as possible, must be withheld from the diet. 
Fats, however, being the other factor in the produc- 
tion of heat and energy should be given in larger 
amounts than usual, if the patient can digest them. 

Foods Allowed in Diabetes. — The following 
foods are allowed in diabetes: meat soups and broths 
which are not thickened with any farinaceous sub- 
stances; beef tea; all kinds of fish, meat, game, and 
poultry; eggs, gluten, almond and bran bread and 
cakes; string beans, green vegetables, tomatoes, 
mushrooms, oyster plant, radishes, pickles, and 
onions; custards, jellies, creams, walnuts, almonds, 
filberts, Brazil nuts, cocoanuts, pecans, cherries, cur- 
rants, strawberries, lemons, tea and coffee. All 
sweetening must be done with saccharine. 
. Foods to be Avoided in Diabetes. — The following 
foods should be avoided: liver, sugar, starches of any 
kind, beets, potatoes, carrots, turnips, peas, all 
fruit and nuts except those mentioned above, pastry, 
puddings, and sweet or sparkling wines and cordials. 

Diarrhcea. — Food that will be nearly, if not entirely 
digested in the stomach is required in the first stages 



49 6 Practical Nursing 

of dysentery and diarrhoea. Therefore all solid 
food is forbidden, and even beef tea and meat broths 
must be given sparingly, arrowroot, gruel, milk 
soups, barley water, and albumin water being prefer- 
able. As the symptoms abate, the diet can be slowly 
increased by the addition of farinaceous foodstuffs, 
scraped beef, broiled steaks, etc., but all rich foods 
and foods likely to irritate the intestinal tract, such 
as are purposely given in constipation, should be 
avoided. 

Dyspepsia. — The most common causes of dyspepsia 
are: other diseases; food taken in large quantities, 
in improper proportions, at too frequent intervals, 
or too hastily swallowed; food that is in itself indi- 
gestible, or that has been rendered so by improper 
cooking or by being too highly seasoned. These 
errors must of course be guarded against in the treat- 
ment. Food must be taken in small quantities, at 
regular hours; it must be well masticated, before 
being swallowed, and only such as can be easily 
digested must be allowed. All rich or highly seasoned 
dishes, fat meats (such as pork, goose, duck), all 
''cooked over" meats, or pickled meats and fish, fried 
food, game, crabs, lobsters, sausages, candies, and 
articles of a like nature are to be avoided. 

The following table of the comparative digestibility 
of food is given by several writers. The articles 
are mentioned in the order of their digestibility, begin- 
ning with that which is most so. 
i. Oysters. 



Toast. 

Soft-cooked eggs. 

Bread cereals and milk pudding. 

Sweetbreads. 



Food 497 



6 



Whitefish, broiled or boiled. 



7. Chicken, boiled or broiled. 

8. Lean roast beef or steak. 

9. Eggs scrambled or omelet. 

10. Mutton, roasted or boiled. 

11. Squab, partridge, bacon. 

12. Roast chicken, capon, turkey. 

13. Tripe, brains, liver. 

14. Roast lamb. 

15. Chops, mutton or lamb. 

16. Corned beef. 

17. Veal. 

18. Ham. 

19. Duck, snipe, venison. 

20. Rabbit. 

21. Salmon, mackerel. 

22. Herring. 

23. Roast goose. 

24. Lobsters, crabs. 

25. Smoked, dried, or pickled fish and meat. 
Fever. — Fever is characterised by excessive tissue 

waste, diminished secretion of hydrochloric acid, and 
lessened peristaltic action. The dietetic treatment 
therefore must aim at supplying sufficient nourishment 
to save too great tissue- waste ; but in a form that will 
be digested easily and quickly, and absorbed as com- 
pletely as possible. There should be a certain per 
cent, of nitrogen in the diet and an abundance of 
liquid, that the thirst may be relieved, and the kidneys 
may be flushed of the excessive waste matter pro- 
duced by increased metabolism. Milk answers these 
requirements better than any other food, and should, 
therefore form the bulk of feeding in fever. Meat 
extracts and broths may, in most cases, be given 



49 8 Practical Nursing 

occasionally, when variety is desired; but, as has been 
already stated, they contain little nourishment- 
Tea and coffee may be given sometimes, but should 
be avoided when there is restlessness or insomnia. 
The use of tea is particularly counterindicated when 
there is any tendency to indigestion. 

In convalescence, solid food must only be resumed 
gradually. This is especially true of typhoid fever, 
since in this disease the intestinal tract, even for 
some time after the temperature has reached normal, 
is the seat of a slowly healing ulcerative and inflam- 
matory process, which food that has escaped gastric 
digestion may irritate. Oysters, eggs, and well cooked 
farinaceous food are the first solids allowed. When 
meat is first given, it should be shredded, as it is 
thus rendered easier to digest. 

Nephritis. — Nitrogenous waste being eliminated 
by the kidneys, proteid food should be limited in 
nephritis. Meats must at all times be given sparingly, 
and during acute attacks they should be entirely 
withheld. Otherwise, not only will the kidneys be 
given extra work, but their failure to perform that 
which has been given them to do will cause a clogging 
of the system with the waste product of nitrogen — 
urea. To avoid this, a milk diet is generally given 
during the height of an acute attack, and during 
convalescence and in chronic cases, such articles as 
are contained in the following list : 

Vegetable, farinaceous, and fish soups; boiled or 
broiled fresh fish, raw oysters, clams, chicken, game, 
fat bacon, cereals of all kinds, cereal and milk pud- 
dings, stewed and raw ripe fruits. Tea and coffee 
are allowed, if taken in small quantities and weak. 

Phthisis. — Rich, but easily digested and not too 



Food 499 

highly seasoned, food should be given in all forms of 
tuberculosis. If there are pronounced dyspeptic or 
febrile symptoms, the diet must consist of milk, or 
milk and raw eggs. At other times, cream, fresh 
butter, oil salad dressings, bacon, custards, milk 
puddings, cocoa, chocolate, rare beef steak, potatoes, 
and green vegetables are all valuable articles of diet. 

Rheumatism. — Owing to the excess of acid in the 
system in this disease, those foods likely to generate 
acid in the course of their digestion, must be avoided. 
Of this class are the sugars and the red meats. All 
rich or highly seasoned food must also be withheld 
from the diet. 

The following diet is allowed in rheumatism: 
mutton and chicken broth and beef tea, in small 
quantities; raw clams, oysters, boiled fresh fish, 
chicken sweetbread, broiled bacon; whole wheat, corn 
or brown bread, toast, arrowroot, rice, green vege- 
tables, fruits — except strawberries and bananas. All 
sweetening should be done with saccharine. 

Rickets. — Rickets being due to a lack of fat and 
proteid food, starchy foods should be avoided. 
To young babies who are bottle-fed, give properly pre- 
pared milk. Avoid condensed milks and patented 
foods. To older children, give beef tea, mutton 
broth, eggs, milk, and fresh fruit juice, especially 
orange juice. If the child is old enough to have meat, 
give rare meat and vegetables. 

Scurvy. — Scurvy is due to a lack of salts in the 
food. Therefore give fruit juices, especially lemon 
and orange fruit, fresh vegetables, and meat. 



CHAPTER XXV 

MASSAGE 

THE ''Swedish movement cure" was introduced 
into Sweden, in 1813, by Peter Henrik Ling, 
and was revised, in i860, by Mezger of Amsterdam. 
The movements which they practised and taught 
were not original. Their fundamental principles 
were the same as those described in Chinese writings 
three thousand years earlier; the same as those used 
by the Brahmins of India, by the Egyptian priests, 
by Hippocrates, Galen, Rufus of Ephesus, and other 
physicians of ancient Rome and Greece, and by 
Hoffman and other noted physicians of the Middle 
Ages. 

To be an expert masseuse requires a thorough 
knowledge of anatomy, and constant practice. The 
limited number of lessons in massage generally included 
in the curriculum of a nurse's course does not fit her 
to undertake the treatment of severe cases. The ob- 
ject of these lessons is simply to teach those elementary 
movements of massage which enter largely into the 
treatment of nervous diseases and of diseases requir- 
ing stimulation of the circulation, and which are em- 
ployed where ankylosis of the joints is liable to 
complicate accident or disease. 

Before taking up the study of massage, it is neces- 

500 



Massage 



501 



sary to have a general idea of the anatomy of the 
body, to know the position of the bones, the origin 
and insertion of the principal muscles, and the location 
of the larger arteries, veins, and nerves, and their 
functions. 

Medical gymnastics, known variously as " Swedish 
movements," "movement cure," etc., is "a sys- 
tematic exercise of the muscles and other tissues 
of the body for therapeutic purposes." 

Some authors make a distinction between Swedish 
movements and massage, including under the former 
class the active movements, and under the latter 
the five primary passive movements. Others class 
all movements, both active and passive, under the 
heading of "medical gymnastics," thus: 

Medical Gymnastics 



Passive 

Movements. 



1. Effleurage or stroking 

2. Friction or rubbing 

3. Petrissage or kneading 

4. Tapotement or percussion 
=;. Pressure 



Massage, 



Passive 
Movements. 



6. Vibration 

7. Circumduction 

8. Rotation 

9. Flexion 
10. Extension 



Active 



I 1. Assistive 
MoVBMBKTS. \ I |^g ive 



Swedish 
Movements. 



Points to be Remembered 

Massage must never be given without a doctor's 
order. Its use is counterindicated in all inflamma- 
tory conditions associated with pus, in skin diseases, 
diseases accompanied with a rash, or parasitic 
diseases. 



502 Practical Nursing 

Before beginning a treatment, place the patient 
in a comfortable position, and sit in a comfortable 
position yourself, neither too far away from him nor 
too near him. 

Always wash your hands before and after a treat- 
ment. 

Lubricants may be used if desired, but, unless 
ordered for therapeutic purposes, are not necessary 
unless the skin is very dry. If the skin is 
moist it is often desirable to employ talcum 
powder. 

In beginning a manipulation, use moderate force, 
increase the force gradually, and then, toward the 
end of the movement, decrease it as gradually. 

Begin and end all treatment with effleurage. 

Local treatment is given for from ten to twenty 
minutes. 

General treatment is given for from half an hour 
to one hour. 

Before giving local massage, loosen all bands around 
the part to be manipulated, and give effleurage and 
petrissage to the adjacent parts between it and the 
heart. 

Always give effleurage, petrissage, and friction 
directly on the skin. 

In general massage, the patient should wear a 
loose gown. 

Never expose your patient. 

Carry out a general treatment in the following 
order: feet, legs, arms, chest, abdomen, back. 

Effleurage. — Effleurage is given from the peri- 
phery toward the heart. It may be given with the 
palms of one or both hands, or with the cushions of the 
fingers or thumbs. 



Massage 5°3 

f The superficial circulation is improved. 
I Exudations are pushed along in the capillaries. 
Effects. ■{ The cutaneous nerves are soothed by light effleur- 
age given for a short time, but are irritated 
by prolonged treatment. 

Effleurage is given at the beginning and ending of 
all treatments. 

Friction. — Friction is given with the heel of the 
hand, the cushion of the thumb, or the fingers. To 
give friction, make small successive circles over the 
prescribed area without moving the skin, exerting 
considerable pressure when not too painful. Always 
follow friction with effleurage. 



( The inflammatory products are broken up and 
moved on into the veins and lymphatics, 
' J thus hastening absorption. 

\ Local circulation is stimulated. 



Petrissage. — Petrissage, or kneading, can be 
done with one hand or both hands, with the cushions 
of the fingers or of the thumb. The muscles are 
stretched away from the bone in the direction of the 
venous current, and the blood-vessels are alternately 
emptied and refilled by the alternate pressure and 
relaxation of the operator's hand while performing 
the movement. 

In giving petrissage begin above and work down- 
ward. 

Never allow the hand to move on the skin. When 
one grasp of the muscle is thoroughly kneaded, relax 
the hand and take a new grasp, including a portion 
of the former one. 

Use both hands whenever possible, 



504 



Practical Nursing 



Effects. 



1 



Make the greatest pressure while moving the muscle 
in the direction of the venous current. 

The circulation is improved. 
Blood pressure is diminished. 
Mental activity is lessened. 
The absorption of waste products is hastened. 
Nerves and muscles are strengthened. 
Swellings and effusions are reduced. 
Gentle petrissage stimulates tissue growth. 
Hard petrissage lessens tissue growth. 

Tapotement. — Tapotement, or percussion, may 
be given with the ulnar edge of the hand, the palm 
of the hand, the tips of the fingers, or the closed hand. 
It is known, according to the method employed, as 
ulnar, palmar, digital, or fistic percussion. It may 
be given with one hand or both hands, and the appli- 
cation of the latter may be alternated or simultaneous. 

Ulnar percussion is generally used upon the 

back. 
Palmar (simultaneous), on the extremities. 
Fistic (either alternate or simultaneous), on 

the glutei. 
Digital (either alternate or simultaneous), on 

the head. 
Moderate percussion causes contraction of the 

blood-vessels. 
Moderate percussion increases the irritability 

of the nerves. 
Moderate percussion applied across muscles 

increases their contractibility. 
Effects. Prolonged percussion causes the dilatation of 

the blood-vessels. 
Prolonged percussion causes temporary para- 

ly sat ion of the nerves. 
Prolonged percussion applied across muscles 

will loosen contraction. 

Pressure. — Pressure is given with the cushion of 



V. 



Massage 5°5 

the fingers or with the knuckles, and usually follows 
the course of nerves or vessels. 

( Pressure is sedative in neuralgic pains. 
Effects. ■< Pressure causes local paralysation of muscle. 

( Pressure causes secondary increase of circulation. 

Pressure should only be used by those thoroughly 
instructed in anatomy. 

Vibration. — To give vibration, grasp the part to 
which vibration is to be given between the hands, 
fix your arms firmly and hold them stiffly, producing 
a tremor in them which will be transmitted to the 
part of the body between your hands. 

( Vibration produces stimulation in palsies. 
Effects. •< Vibration acts as a counter-irritant. 

( Vibration produces changed nutrition. 

Circumduction. — Circumduction may be either 
passive or active. 

In circumduction, ''some part of the body is made 
to describe with its longitudinal axis the surface of 
an imaginary cone. " The circle is made as large as 
the joint permits. Large limbs are moved slowly, 
small ones more quickly. 

( Blood is drawn from the moving extremity. 
J Absorption is increased. 
J Tendons, etc., are made more pliable. 
^ Articular adhesions are broken up. 

Rotation, Flexion, etc — The names describe 
the movements. The effects are those of assistive 
or resistive movements in a less marked degree. 

Active Movements. — Active movements are either 
single, assistive, or resistive. 

Single movements are those performed by the 
patient and constitute the movements of educational 
gymnastics. 



506 



Practical Nursing 



In assistive movements the operator helps the 
patient. 

In resistive movements the operator resists the 
patient. 

These movements should be given slowly and 

evenly. 

Co-ordination is increased. 
The circulation is improved. 
Absorption is hastened. 
Metabolism is improved. 
Effects, -s Nutrition is improved. 

Adipose tissue is lessened. 
Muscular tissue is hardened. 
Adhesions are broken up. 
Joints are made more pliable. 



GLOSSARY 

Abduct, to draw from the median line. 

Abductor, a muscle that draws from the median line. 

Abortion, the expulsion of an immature foetus. 

Acme, the crisis or highest point of a disease. 

Acne, a popular eruption due to the retention of secretion 
in the sebaceous glands. 

Acoustic, pertaining to sound, hearing, or the ear. 

Acute Disease, a disease of short duration. 

Adduct, to draw toward the centre. 

Adduction, movement toward the centre. 

Adductor, a muscle that performs adduction. 

Aden, a gland. 

Adenitis, inflammation of a gland. 

Adenoid, an adenoma or glandular tumour. 

Adhesion, the adhering of two surfaces. 

Adipose, fatty tissue. 

Adiposis, fatty degeneration, corpulence. 

Adnexa, appendages. 

Adnexa Uteri, the Fallopian tubes and ovaries. 

Adolescence, the period between puberty and full ma- 
turity. 

Adrenal, near the kidney, the suprarenal capsule. 

^robia, organisms which require air or oxygen to maintain 
life. 

After-birth, the placenta and membranes. 

Agar- agar, a gelatinous substance made from a seaweed 
found on the coast of China and Japan. 

Agent, any power or substance that is capable of pro- 
ducing changes in the body. 

Agglomerate, a mass. 

Agglutination, the adhering or joining together, as of the 
edges of a wound. 

507 



508 Practical Nursing 



Aggregate, formed in clusters. 
Ague, malarial or similar fever. 
Albumen, the white of egg. 

Albumin, one of the most important proteid substances. 
Aleukemia, a deficiency of the proportion of white cor- 
puscles in the blood. 
Alienation, mental derangement. 
Alienist, a physician who is an expert in the treatment 

of mental diseases. 
Aliment, food. 

Alimentary, having the property of nourishing. 
Alkali, substance which in combination with acids will 

form salts, and with fats, soaps. 
Alkaline, having the reaction and properties of an alkali, 

(An alkaline substance will turn red litmus paper 

blue.) 
Alkaloid, an alkaline base of vegetable origin. 
Amceba, an embryonic cell. 

Amenorrhea, absence or irregularity of the menses. 
Analgesia, loss of sensibility to pain. 
Analogous, being similar in certain particulars. 
Analysis, the separation of a body into its elements. 
Anaemia, a deficiency in the amount of hemoglobin or of 

red blood corpuscles in the blood, or in the amount of 

blood. 
Anaesthesia, loss of feeling or sensation. 
Aneurysm, a sac formed in the walls of an artery by 

dilatation. 
Angioma, a tumour composed of blood-vessels. 
Ankylosis, abnormal union of the bones of a joint. 
Anodyne, a medicine that relieves pain. 
Anorexia, lack of appetite. 
Aperient, a mild cathartic. 
Aphasia, defect of the power to understand spoken or 

written language or to express thoughts by such 

means. 
Aphonia, a loss of voice not due to a central lesion. 
Arthritis, inflammation of a joint. 
Ascites, an accumulation of serous fluid in the abdominal 

cavity. 
Asepsis, free from septic matter. 



Glossary 509 

Ataxia, a lack of muscular coordination. 

Atony, general debility. 

Atrophy, the wasting of a part from defective nutrition. 

Auditory, pertaining to the sense or organs of hearing. 

Aura, a phenomenon that precedes epileptic attacks. 

Auricular, pertaining to the ear. 

Base, the fundamental part of any substance. The non- 
acid part of a salt. 

Beaker, a wide-mouthed glass vessel. 

Benign, not malignant, mild. 

Binocular, pertaining to both eyes. 

Bougie, an instrument used to dilate the urethra and other 
canals. 

Bubo, an inflammatory swelling of a lymphatic gland. 

Calculus, a stone-like concretion occurring in the body, 

usually composed of mineral salts. 
Callous, hard, like callus. 
Callus, the plastic exudate which occurs between the 

ends of a fractured bone. 
Camisole, a jacket used for restraint. 
Cannula, a needle-like tube used for aspirating. 
Capsule, a soluble case in which medicine is enclosed, a 

fibrous or membranous envelope enclosing a part, as 

the kidney or spleen. 
Concentric, having a common centre. 
Crepitus, a grating, crackling sound. 
Crisis, the turning point of a disease. 
Cuticle, the epidermis or outer skin. 
Cutis, the derma or true skin. 
Cyst, a sac containing a liquid or semisolid. 
Cystalgia, pain in the bladder. 
Cystitis, inflammation of the bladder. 

Dermatitis, inflammation of the derma. 
Diagnosis, the distinguishing of one disease from another. 
Diapharetic, an agent that increases the perspiration. 
Diastase, a ferment contained in malt, which converts 

starch into dextrose. 
Diathesis, a predisposition to certain diseases. 
Dyspncea, Dyspnea, difficult or laboured breathing. 



5io Practical Nursing 



Eccentric, peculiar, proceeding from a centre. 
Ecchymosis, an extravasation of blood into the tissue. 
Efferent, conveying impulses from a nerve centre, and 

blood, serum, etc., from a part. 
Effusion, the escape of fluid into the tissues or cavities 

of the body. 
Embolism, the plugging of an artery or vein by an embolus. 
Embolus, a blood-clot or other plug brought by the blood- 
current from a distant vessel and obstructing the 

circulation. 
Emetic, any agent that causes vomiting. 
Emollient, an agent that softens or sooths. 
Emphysema, swelling or inflation of the tissues by air or 

other gases. 
Empyema, an accumulation of pus in the pleural cavity. 
Endemic, peculiar to or prevalent in a certain locality. 
Epithelioma, a malignant growth of the skin. 
Epithelium, the outer covering of the skin and mucous 

membranes. 
Erythema, a morbid redness of the skin. 
Exacerbation, increased severity of a disease. 
Extravasation, an escape, as of blood, from a vessel into 

the tissues. 

Follicle, a small secretory or excretory sac or gland. 
Fomes, any porous substance that absorbs contagion. 

Gastric, pertaining to the stomach. 
Genital, relating to the organs of generation. 
Gravity, the property of possessing weight. 

Hematoma, Hematoma, a tumour containing blood. 

Hematuria, Hematuria, blood in the urine. 

Haemoglobin, Hemoglobin, the colouring matter of red 
corpuscles. 

Haemoptysis, Hemoptysis, the spitting of blood. 

Hemorrhoid, Hemorrhoid, a small vascular tumour at the 
anus. 

Haemostatic, Hemostatic, an agent that arrests hemor- 
rhage. 

Hepatic, relating to the liver, 



Glossary 5 1 1 

Hyperbiophy, the abnormal enlargement of an organ 

or part. 
Hypnotic, an agent that causes sleep. 

Impacted, driven firmly in. 

Incipient, the beginning. 

Induration, the abnormal hardening of a tissue or part. 

Inertia, inactivity, sluggishness. 

Infarct, an obstruction. 

Infiltrate, the accumulation of abnormal substances 

in a tisuse. 
Inflation, distention. 
InHiBiT, to restrain. 
Innoxious, harmless. 

Inoculation, the insertion of a virus into the system. 
Insolation, treatment by exposure to the sun. Sunstroke. 
Interstitial, situated in the interspaces of a tissue. 

Lacerated, torn. 

Lesion, change in the structure of the tissue as the result 

of injury or disease. 
Lymph, a transparent liquid of alkaline reaction contained 

in the lymphatics. 
Lymphatics, small tubes which permeate the body and 

convey lymph. 

Malignant, virulent, fatal. 

Malaise, a feeling of indisposition. 

Metabolism, the changes, constructive and destructive, 

that take place in the cells composing the tissues of 

the body. 
Miasma, a noxious exhalation or emanation. • 
Monoplegia, paralysis of a single part. 
Morbid, diseased. 

Motile, having a spontaneous but not conscious movement. 
Mucous, having the nature of mucus. 
Mucous Membrane, the membrane that lines the cavities 

and canals of the body which connect with the open 

air. 
Mucus, the viscid watery secretion of the mucous glands. 
Myelitis, inflammation of the spinal cord. 
Myositis, inflammation of a muscle. 



5i2 Practical Nursing 



Narcotic, a drug that will both produce sleep and allay 

pain. 
Necrosis, death of a tissue, especially bone. 
Neural, pertaining to the nerves. 

Occlusion, the state of being closed. 

(Edema or Edema, accumulation of watery liquid in the 

cellular tissue. 
Osteitis, inflammation of the bone. 
Osteomyelitis, inflammation of the bone-marrow. 

Periostitis, inflammation of the periosteum. 
Peritonitis, inflammation of the peritoneum. 
Petechia, a small spot under the skin caused by the 

effusion of blood. 
Phlebitis, inflammation of a vein. 
Pigment, colouring matter. 

Plasma, the fluid portion of the blood and lymph. 
Pledget, a small compress of lint or other soft substance. 
Prognosis, the prediction of the course and termination 

of a disease. 
Pruritis, intense itching. 
Remittent, a fever characterised by periods of abatement 

and exacerbation. 
Rhinitis, inflammation of the mucous membrane lining 

the nose. 

Sarcolemma, a delicate membrane which invests muscle 

fibre. 
Segment, a small piece. 
Septic, due to putrefaction. 

Serum, the. fluid constituent of any animal liquid. 
Sinus, a cavity or space. 
Spasm, a sudden rigid muscular contraction. 
Specific, peculiar to, special. 

Stasis, a stoppage of the blood-current in any part. 
Stenosis, a narrowing or constriction of a duct or canal. 
Stricture, the narrowing of a duct or tube. 
Stridulous, a harsh grating sound. 

Styptic, any astringent drug that will check haemorrhage. 
Sublimate, the product of vapourisation and recondensa- 

tion. 



Glossary 513 



Sudor, sweat. 



Thrombus, a plug or clot in a vessel which remains at the 

point of formation. 
Tinnitus, a ringing in the ears. 
Torsion, twisting. 
Torticollis, a contracted condition of the cervical 

muscles. 
Traction, drawing or pulling. 
Tremor, an involuntary trembling of the body. 
Tympanites, a distention of the abdomen due to uhe 

presence of gas or air in the intestines or peritoneal 

cavity. 

Ulcer, an open sore. 

Urticaria, hives or other skin eruption of a like nature. 

Vascular, pertaining to or well supplied with vessels. 
Venesection, opening a vein. 
Vesicle, a small blister. 
Virus, an animal poison. 
Viscid, glutinous. 

Vitellin, a proteid substance contained in the yolk of 
eggs. 



INDEX 



Abscess, perinephritic, 450 

Acid, boric, 30; 
oxalic, 30 

Acme, 450 

Active movements, 505 

Addison's disease, 429 

Adenoids", 417 

Albumin, test for, 155 

Alcohol, 26 

Ammonia as a counter-irri- 
tant, 138 

Anaemia, 429; 
diet in, 494 ; 
pernicious, 430 

Aneurism, 428 

Angina pectoris, 425 

Animal parasites, diseases 
due to, 402 

Ankylostoma duodenale, 403 

Anteflexion, 451 

Anteversion, 451 

Anthrax, 345 

Antiphlogistine, application 

of, 145 
Antiseptics, the, 30 
Antitoxines, 304 
Anuria, 150 
Apoplexy, 408 

treatment of, 231 
Apothecaries' weight, 192 
Appendicitis, 437 
Applications, cold, action of, 

143 
Arachnids, scabies, itch, 403 
Arteries, diseases of, 428 
Arterio-sclerosis, 428 
Ascaris lumbricoid.es, 402 
Ascites, 440 



Aspiration, abdominal, pre- 
paration for, 295 

Aspiration, pericardium, pre- 
paration for, 299 

Asthma, bronchial, 422 

Auditory nerve, diseases of 
the, 462 

Auricle, diseases of the, 459 



B 



Bacteria, manner of growth, 
22 ; 
methods of destroying, 23; 
nature and classification, 

19; 
those which cause morbid 

processes in wounds, 2 1 

where found, 21 

Bacteriology, history of, 13 

Bags, hot-water, used as 

counter-irritants, 132 
Bandage, Barton's, 252; 

breast, suspensory, 253; 

breasts, for both, 254; 

capeline, 250; 

chin, tailed for, 261; 

circular, 247; 

elbow, 258; 

eye, monocle, 251 ; 

eyes, binocle, 252; 

figure-eight, 248; 

foot, 259; 

forearm, 256; 

four-tailed of knee, 262; 

fundamental, 247; 

handkerchief, for the foot, 
269; 

hand, 256; 



515 



5i6 



Index 



B andages — Co ntinued 

handkerchief, hand, for 

the, 268; 
handkerchief, heel, for the, 

269 
head, four-tailed for, 260; 

head, side of, 251 ; 
heel, 260; 
how to make, 243; 
plaster, how to apply, 245; 

plaster, how to remove, 

246; 
recurrent, 249; 

recurrent of head, 249; 
scalp, front of, 250 
scultetus, 262 ; 
shoulder, spica, for, 256; 
spiral, 247; 

spiral reverse, 247; 
T, of the chest, 264; 

T, of the perineum, 264; 
Velpeau's, 255 
Baths, bicarbonate of soda, 

128; 
bran, 128; 
Brandt, 117; 
cabinet, 125; 
Carlsbad, 129; 
cleansing, 108; 
cold sponge, 119; 
cold tub, 115; 
continuous, 127; 
foot, 126; 
hot, 121 ; 
hot air, 123 ; 
in bed, 109; 
infants' cleansing, 112; 
in hyperprexia, 115; 
local, 126; 
medicated, 128; 
mustard, 133 ; 
Nauheim, 129; 
salt, 129; 
sitz, 126; 
slush, 120; 
starch, 128; 
sulphur, 128; 

to induce perspiration, 122; 
relax spasms, 121; 
uses of, 107; 
vapor, 125 



Bed, closed, how to make, 52 ; 

ether, how to make, 54; 

fracture, how to make, 55; 

how to draw patient up 
in, 61 ; 

how to make with patient 
in it, 55; 

how to move patient from 
one bed to another; 

sizes of, 45 
Bed-pan, how to give and 

remove, 70 
Bed-sores, care and preven- 
tion of, 71 ; 

how to dress, 73 
Bichloride of mercury, 26 
Binder, abdomen, straight, 
for the, 266; 

chest, straight, 266; 

Y, for the breast, 265 
Blankets, best kind of, 48; 

care of, 49; 

disinfection of, 49 
Blood, cultures, 313; 

disease of, 429; 

in disease, 310; 

nature of, 308; 

smears, 312 
Bones, diseases of, 456 
Bradford frame, 75, 279 
Brain, abscess of, 408; 

diseases of, 408; 

oedema of, 410 
Brass, how to clean, 44 
Breathing, stertorous, 106 
Bronchitis, 421 
Burns and scalds, treatment 

of, 214 



Calculi, pancreatic, 445 
Cantharides, application and 

removal of, 142 
Caps, ice, 144 
Carbohydrates, 477 
Carbolic, 27 
Cardiac disease, 494 
Caries, 456 
Catgut ligatures, chromicised, 

preparation of, 325 



Index 



5i7 



Catgut ligatures, preparation 
of, 326 

Catheterisation, 160 

Catheters, manner of cleans- 
ing and sterilising, 162 

Cautery, Pacquelin's, 140; 
substitute for, 141 ; 
use of, 140 

Chair, how to get patient up 
in, 62 

Charting, 92 

Chicken-pox (varicella), 345 

Chloroform, as a counter- 
irritant, 138 

Chlorosis, 430 

Chocolate, 480 

Cholera, 346 

Cholera infantum, 437 

Chorea, St. Vitus's Dance, 
409 

Circumduction, 505 

Cirrhosis, 442 

Cocoa, 480 

Coffee, 481 

Coils, ice, 144 

Colic, 438 

biliary or hepatic, 443 

Colitis, acute, 438; 
chronic, 439*. 

Collapse, treatment of, 233 

Compensation, concerning, 
424 

Compresses, cold, for the 
eye, 145; 
for the head, 145 

Constipation, diet in, 495 

Contusions, treatment of, 216 

Convulsions, treatment of, 

233 
Copper, how to clean, 44 
Cornea, diseases of the, 465 
Counter-irritants, nature of, 

131; 
reason for application of, 

131; 
varieties of, 131 
Creoline, 28 
Croup, 420 
Croup-tent, 205 
Culture Media, bouillon for, 
15; 



preparation of, 15 
Cupping, dry, 138 

wet, 140 
Cystitis, 450 
Cystocele, 452 



Dengue (break-bone fever), 

35i 
Diabetes, diet in, 495 
Diabetes mellitus, 405; 

insipidus, 406 
Diarrhoea, diet in, 495 
Diarrhoeas of children, 439 
Digestive Organs, diseases of, 

433 
Diphtheria, 348 

Disease, definition of, 337; 

stages in infections, 338 
Disinfectants, the, 25 
Disinfection, 25 

in contagious disease, 340; 

in infectious diseases, 339 
Dislocations, treatment of, 

217 
Douche, aural, 169; 

intra-uterine, 167; 

nasal, 168; 

spinal, 167; 

vaginal, 165 
Dressings, surgical, prepara- 
tion for, 290; 

testing of, 16 
Dropsy, oedema, 445 
Drowning, 234 
Ducts, lachrymal, diseases of 

the, 463 
Dysentery, 352 
Dysmenorrhcea, 454 
Dyspepsia, diet in, 496 
Dyspnoea, 105 



E 



Ear, diseases of the, 459; 
nursing in diseases of the, 
462 
Eclampsia, 410 
Eczema, 457 
Efrleurage, 502 



5i8 



Index 



Emergencies, 213 
Emphysema, 423 
Encephalitis, 410 
Endocarditis, 426; 

malignant, 379 
Endometritis, 451 
Enemata, abdominal flushing 
179 

carminative, 174; 

emollient, 175; 

method of giving where 
only a small amount of 
fluid is used, 172; 

medicated, 179; 

nutritive, 175; 

purgative, 176; 

sedative, 180; 

stimulating, 180; 

use of, 171 ; 

varieties of, 171 
Enteritis, 439 
Epilepsy, treatment for, 234, 

410 
Epithelioma, 457 
Erysipelas, 354 
Erythema, 458 
Examination, gynaecological, 

preparation for, 283 
Extensions, Bucks, 275 
Eye, diseases of the, 462 
Eyelids, diseases of the, 462 
Eye, nursing in diseases of 

the, 468 



Faeces, examination of, 183; 

odor of, 184 
Fainting, treatment for, 234 
Fat, use of, in the body, 478 
Favus, 458 
Feeding, infant, 488 
Fever, diet in, 497 
Filaria, 403 
Flexion, 505 

Floor, methods of cleaning, 41 
Fomentations, for the breast, 

137; 
for the eye, 137; 
turpentine, 136 
Food, absorption of, 483 ; 
digestion of, 481; 



elements of, 472; 

nitrogenous, 474; 

non-nitrogenous, 477; 

rules governing the cooking 
of, 484; 

serving of, 493 ; 

uses of, 472 
Foreign bodies in the ears, 

nose, trachea, and tissues, 

217 
Formaldehyde, 28 
Fractures, 219 
Friction, 593 

Furniture, methods of clean- 
ing, 42 
Furunculosis, 458 



Gastritis, 436 

Gavage, 187 

Glands, ductless, diseases of, 

429; 
lachrymal, diseases of the, 

463 
Glossitis, acute, 433 
Glucose Fehlinop's test for, 

m 156; 

fermentation test for, 157 

Goitre, 433; 

exophthalmic, 433 

Gonorrhoea, 355 

Gout, 406 

Guaiacol and glycerin, appli- 
cation of, 138 



H 



Haemoglobin, 311 
Haemoglobin wria, 157 
Haemophilia, 432 
Haemorrhage, means of arrest- 
ing, 222 
Hair, how to arrange pa- 
tient's, 77; 
washing the, no 
Hand, care of, 4; 

disinfection of, before op- 
erations, 324; 
disinfection of, for surgical 
dressings, 290 



Index 



S f 9 



Hay fever, 418 
Health, care of, 2 
Heart, dilatation of, 425 

diseases of, 424; 

fatty, 426; 

hypertrophy of, 426; 

valvular diseases of, 427 
Heating, methods of, 38 
Herpes Zoster, shingles, 411, 

458 
Hiccough, 106 
Hodgkin's disease, 431 
Hydrocephlus, 411 
Hydrogen, peroxide of, 30 
Hydrophobia (rabies), 356 
Hydrosalpinx, 455 
Hydrothorax, 423 
Hypodermoclysis, 300 
Hysteria, 235, 412 



Inclined plane, 278 
Inflammation, causes of, 130; 

character of, 130; 

healing of, 130 
Influenza, 357 
Instruments, cleaning and 

sterilisation of, 286, 325 
Intoxication, treatment for, 

23 6 

Intravenous infusion, 303 

Intubation, 305 

Iodoform gauze, preparation 

of, 325 
Irrigation, bladder, 163; 

rectal, 180 
Itch, 458 



Jaundice, 443; 

icterus neonatorum, 444 

K 

Kidneys, congestion of, 446; 
diseases of, 445 ; 
floating, 446 



Labyrinth, diseases of, 459 



Laryngitis, acute catarrhal, 

419; 

chronic, 420; 

tubercular, 421 
Larynx, oedema of, 420; 

syphilis of, 421 
Lavage, 185 
Leaf, mustard, 133 
Leeches, application of, 146 ; 

care of, 147 
Leprosy, 358 
Leukaemia, 431 
Ligatures, horsehair, 327; 

silk-worm gut, 327 
Lime, chlorinated, 28; 

milk of, 28 
Linen, amount required, 51; 

disinfection of, 48 ; 

how to remove stains from, 

49 
Liniments, application of, 

.138 

Liver, abscess of, 441; 

carcinoma of the, 442 ; 

fatty, 442 
Locomotor attaxia, 413 
Lumbar puncture, 299 
Lung, abscess of, 422; 

congestion of, 423; 

gangrene of, 423; 

oedema of, 423 
Lupus, 458 
Lysol, 27 



M 



Malaria, 359 

Malta Fever (Mediterranean 

fever), 362 
Massage, history of, 500; 

movements of, 501; 

points to be remembered 
when giving, 501 
Mattress, air, 46; 

disinfection of, 46; 

how to turn and change, 
with the patient in bed, 

59; 
material uses for, 46; 

water, 46 



5 20 



Index 



Measles (nubeola), 362; 

German (nubella), 364 
Medicine, absorption of, 198; 

administration of, 190; 

case, 211; 

eye, applied to the, 209; 

hypodermic, given with, 
202 ; 

inhalation, given by, 205; 

lists, 210; 

order book, 210; 

rectum, given by, 208; 

rules for giving, 199, 
Meningitis, 365 
Menorrhagia, 454 
Menstruation, abnormalities 

attending, 453 
Metric system, 193 
Metrorrhagia, 454 
Middle ear, diseases of the, 

460 
Milk, 476; 

modification of, 489 
Minerals, use of, in body, 478 
Mouth, care of patient's, 70 
Mumps (parotitis), 367 
Muscles, diseases of, 455 
Mustard, as a counter-irri- 
tant, 132 
Myelitis, 413 
Myositis, 455 
Myxcedema, 433 

N 

Necrosis, 456 
Nematodes, 402 
Nephritis, 447; 

diet in, 498 
Nephrolithiasis, 449 
Nerve, optic, diseases of the, 

467 
Neuralgia, 413 
Neurasthenia, 413 
Neuritis, localized, 414 
Neuroma, 415 
Neurosis, gastric, 435; 

heart, of the, 426 
Nickel, how to clean, 44 
Nightgown, how to change 

the, 57 





Obstruction, intestinal, 440 
Ointments, application of, 

146 
Oliguria, 150 
Oophoritis, 455 
Operating room, care of, 320; 

temperature of, 321 
Operation, care of patient 
after, 318 

care of patient during, 322 ; 

list of, 332; 

preparation of patient for, 

preparation for in private 
house, 329; 
Orbit, diseases of the, 464 
Osteoma, 456 
Osteomyelitis, 456 
Osteonecrosis 
Osteoperiosteitis 
Ostitis, 456 
Ovary, abscess of, 455 
Oxyuris vermicularis, 402 



Pack, hot, 122 ; 

modified hot, 123 ; 

nerve sedative, for, 113; 
• uses of, 107 ; 
Pads, gauze, for operation, 

327 
Pancreas, abscess of, 444; 

carcinoma of, 445 
Paracentesis, preparation for, 

295 
Paralysis, 415 
Paste, mustard, 133 
Patient, care after death, 77; 

care and comfort of, 77; 

care of, at night, 76; 

how to prepare for the 
night, 75; 

how to restrain, 74 
Pediculosis capitis, 403; 

corporis, 404; 

pubis, 404 
Pericarditis, 427 
Perineorrhaphies, 453 
Perineum, laceration of, 45 2 



Index 



5 21 



Peritonitis, 441 
Petrissage, 593 
Phlebitis, 429 
Phlebotomy, 300 
Phthisis, 386; 

diet in, 498 
Plague, 368 
Pleurisy, 424 
Pneumonia, 369 
Pneumothorax, 424 
Poisons, treatment for, 236 
Polyneuritis, 414 
Polyuria, 150 
Porcelain, how to clean, 44; 

how to remove stains from, 

44 
Position, dorsal lithotomy, 
281; 

dorsal recumbent, 281; 

horizontal or supine, 282; 

knee-chest, 282 ; 

left lateral, or Sims, 282; 

standing, or erect, 282; 

Trendelenberg, 282 
Potassium permanganate, 29 
Pott's disease, 417 
Poultice, digitalis, 135; 

flax seed, 135 ; 

ice, 143; 

mustard, 134; 

starch, 146; 
Pregnancy, extra-uterine, 455 
Pressure, 504 
Pseudoleukemia, 431 
Pulse, compressibility of, 102; 

force of, 1 01 ; 

frequency of, ico; 

how to take the, 100; 

normal, 100; 

rhythm, 102; 

tension of, 102 ; 

volume of, 10 1 
Purpura, 431 ; 

hemorrhagica, 432 
Pyaemia, 379 
Pyelitis, 450 
Pyosalpinx, 455 



Qualification of a nurse, 1 ; 



mental, 






moral, 7 
physical, 2 
Quinsy, 419 



Rectocele, 452 
Regurgitation, 427 
Respiration, artificial, 232; 

Cheyne-Stokes, 105; 

object of, 103 ; 

rate of, 104 
Respiratory organs, diseases 

of, 417 
Retina, diseases of the, 467 
j Retropharyngeal abscess, 418 
, Retroversion, 452 
Rheumatic fever, 374 
Rheumatism, chronic, 406; 

diet in, 499; 

muscular, 407 
Rhinitis, 418 
Rickets, 407 ; 



diet in, 499 



> d u ^ 



Rotation 

Rubber tubing, cleansing and 

sterilisation of, 289 
Rubefacients, varieties of, 132 



Salpingitis, 45 5 
Scabies, 458 

Scarlet fever (scarlatina). 376 
| Sclera, diseases of the, 465 
Scurvy, 432 ; 

diet in, 499 
Septicaemia, 378 
Septic diseases, 378 
Sheet, drip, 114; 

how to change with patient 
in bed, 58; 

rubber, 49 
Shock, treatment for, 228 
Sinapisms, mustard, 133 
Skin, diseases of, 456 
Slings, how to make, 267 
Small-pox (variola), 379 
Soda, chlorinated, 28 
Solutions, how to estimate 
percentage of, 191; 



522 



Index 



Solutions — Continued 

rules to follow in making, 

salt, 30 
Speculum, how to hold, 284 
Spices and Condiments, 480 
Spina bifida, 417 
Spleen, enlargement of, 433 
Splints, 274 
Sponges, cotton, 328; 

gauze, 328; 

reef, 328; 

testing, 16 
Sprains, treatment of, 229 
Stenosis, 427 
Sterilisation, 23 
Stomach, dilatation of the, 

435; 

carcinoma of the, 435; 

ulcer of the, 436 
Stomatitis, aphthous, 434; 

gangrenous, 434; 

parasitic, 434; 

ulcerative, 434 
Strapping, ankle, the, 273; 

chest, the, 270 

knee, the, 272; 

wrist, the, 271 
Stupes, turpentine, 136 
Supports, uterine, how to re- 
move, 285 
Suppositories, 209 
Suppuration, causes of, 131 
Symbols and abbreviations 

used in writing prescrip- 
tions, 194; 

chemical, 197 
Symptoms, chill, 80; 

colour, 80; 

coma, 81 ; 

convulsions, 81 ; 

cough, 821 ; 

cry, 82 ; 

cyanosis, 82; 

delirium, 8^ ; 

dyspnoea, St, ; 

excreta. 83 ; 

expression, 85; 

eyes, 85; 

faeces, 84; 

hearing, 86; 



pain, 87; 

paralysis, 87; 

position, 87; 

rash, 88; 

restlessness, 89; 

singultus or hiccough, 89; 

sputum, 84; 

subjective and objective, 

79; 
sweat, or perspiration, 84; 
tremor, or subsultus, 90; 
tympanites, 90; 
voice, the, 92 ; 
vomiting, 91 
Syphilis, 382 



Tampons, 328 
Tapeworms (cestodes), 403 
Tapotement, 504 
Tea, 481 

Temperature, forces control- 
ling the bodily, 94; 

how to take, 97- 

normal, 95 
Test meals, 188 
Tetanus, 385 

Thermometers, care of, 99 
Thrush, 434 
Thyroid gland, diseases of, 

.433 
Tissue, rubber, preparation 

of, 328 
Tonsillitis, follicular, 418; 

suppurative, 419 
Tonsils, ulcers of, 419 
Treatments, gynaecological, 

281 
Trichina, 403 
Tuberculosis, 386 
Tubing, rubber, sterilisation 

of, 328 
Tympanic membrane , disease 

of the, 460 
Typhoid fever, 389 
Typhus fever, 399 



U 



Uraemia, 450 



Index 



523 



Urates, test for, 154 
Urea, nature of, 152; 

test for, 153 
Urinary calculi, 158 
Urine, albumen in, 154; 

bacteria in, 155 ; 

bile in, 156; 

blood in, 156; 

color of, 150; 

crystals in, 154; 

epithelium in, 154; 

glucose in, 156; 

nature of, 148; 

normal 149; 

odor of, 151; 

pus in, 157; 

reaction of, 152 ; 

renal or tube casts in, 157; 

retention of, 150; 

retention of urine, with 
overflow, 150; 

specimens, collection and 
care of, 158; 

suppression of, 150 
Uterus, diseases of, 451 
Uveal tract, diseases of the, 

466 



V 



Vaccination, 304, 381 
Vaginitis, 452 
Varioloid, 381 
Veins, disease of the, 429 
Ventilation, mechanical, 37 
Ventilation, methods of, 33 
Vertical extension, 278 
Vesicants, use of, 141 
Vibration, 505 

W 

Walls, methods of cleansing, 

40 
Ward, general care of the, 40 
Water, use of, in body, 479 
Whooping cough, 399 
Wood, how to remove stains 

from, 43 
Wounds, healing of, 231 

kinds of, 229; 

treatment of, 230 



Yellow fever, 400 



A History of Nursing 

The Evolution of the Methods of Care for the Sick 
from the Earliest Times to the Foundation of the 
First English and American Training Schools for 
Nurses. 

By LAVINIA L. DOCK, R.N. 

Secretary of the American Federation of Nurses and of 
the International Council of Nurses, etc. 

and M. ADELAIDE NUTTING, T..N. 

Superintendent of Nurses, The Johns Hopkins Hos- 
pital ; Principal of Johns Hopkins Training 
School for Nurses, etc. 

Two Volumes, 8vo. Fully Illustrated. Net, $6.00 

Beginning with the earliest available records of sanitary 
codes which were b 11 It up into health religions, and coming 
down through the ages wherever the care and rescue of the 
sick can be traced, through the pagan civilizations, the early 
Christian works of mercy, the long and glorious hi>tory of the 
religious nursing orders, military nursing orders of the 
crusades, the secular communities of the later middle ages, and 
the revival of the deaconess order which culminated in the 
modern revival under Miss Nightingale, this history is the 
most serious attempt yet made to collect the scattered records of 
the care of the sick and bring them all into one unified and 
sympathetic presentation. 

The story is not told in a dry technical fashion, but 
presents its pictures from the standpoint of general human 
interest in a subject which has always appealed to the sympa- 
thies of men. 

Both Miss Nutting and Miss Dock are well known in 
the nursing world ; Miss Nutting, as one of the foremost edu- 
cators in hospital work, who, as the head of the Johns 
Hopkins Hospital training school, has so distinguished her- 
self for practical work that she has been called to Columbia 
University to take the chair of Institutional Management, 
and her collaborator as a well-known worker for organization 
and progress, and who, as the secretary of the International 
Council of Nurses, has already written much on nursing and 
hospital conditions. 

The hi-tory is amply illustrated, and contains a copious 
bibliography of nursing and hospital history. 

G. P. PUTNAM'S SONS 
New York London 



oohs fox iPjedkal ^tutfjents. 



A Text=Book for Training Schools for Nurses. 

By P. M. Wise, M.D., President of the New York State 
Lunacy Commission ; Medical Superintendent St. Law- 
rence State Hospital ; Professor of Psychiatry, Univer- 
sity of Vermont, etc. With an introduction by Dr. 
Edward Cowles, Physician-in-Chief and Superintend- 
ent McLean Hospital. 

Second edition. Two volumes, illustrated, i6°, sold 
separately, each $1.25 

" This text-book has been adopted by the ten State Hospitals of 
New York, representing approximately four hundred pupils." 

Dr. G. Alder Blumer (the medical superintendent of the Utica 
State Hospital) says: "It is an admirable piece of work. It is 
written very clearly, and in language which can be very readily 
understood by the nurse. It covers the whole ground, and contains 
a great deal of matter not to be found in other books, and with the 
adoption of this book other text-books will not be required for the 
training school." 

A Text=Book of ilateria Hedica for Nurses. 

Compiled by Lavinia L. Dock, graduate of Bellevue 
Training School for Nurses, late superintendent of 
nurses, Illinois Training School for Nurses, etc. 

Fourth edition, revised and enlarged. Fortieth thou- 
sand. 12 net, $1.50 

** The work is interesting, valuable, and worthy a position in any 
library." — N. Y. Medical Record. 

4 * It is written very concisely, and little can be found in it to criti- 
cise unfavorably, except the inevitable danger that the student will 
imagine after reading it that the whole subject has been mastered. 
The subject of therapeutics has been omitted as not a part of a 
nurse's study, and this omission is highly to be commended. It will 
prove a valuable book for the purpose tor which it is intended."— 
N. Y. Medical Journal. 

Medical and Surgical Nursing. 

A Treatise on Modern Nursing from the Physician's and 
Surgeon's Standpoint, for the Guidance of Graduate and 
Student Nurses, together with Practical Instruction in 
the Art of Cooking for the Sick. By H. J. O'Brien, 
M.D. 12 . net, $1.50 



G. P. PUTNAM'S SONS, New York and London 



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